Healthcare Provider Details

I. General information

NPI: 1255449971
Provider Name (Legal Business Name): KAREN B MEBANE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4501
US

IV. Provider business mailing address

966 PIERCE CT
BOISE ID
83712-7447
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1136
  • Fax: 208-422-1243
Mailing address:
  • Phone: 208-345-3548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: