Healthcare Provider Details

I. General information

NPI: 1356437172
Provider Name (Legal Business Name): CLARE ELIZABETH YORK MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 MAIN ST.
SALMON ID
83467
US

IV. Provider business mailing address

203 S. DAISY ST.
SALMON ID
83467
US

V. Phone/Fax

Practice location:
  • Phone: 208-756-6212
  • Fax: 208-756-6336
Mailing address:
  • Phone: 208-756-6212
  • Fax: 208-756-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 15564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: