Healthcare Provider Details

I. General information

NPI: 1134199631
Provider Name (Legal Business Name): CHERISH L SMITH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERISH L ESTEP PA

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E JEFFERSON ST SUITE 300
BOISE ID
83712-6246
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-4100
  • Fax: 208-381-4101
Mailing address:
  • Phone: 208-381-2222
  • Fax: 208-381-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA385
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: