DEREK SCOTT AHLSTROM PA
Individual Provider (NPI-1)
Active
Physician Assistant
Provider Information
- NPI Number
1174096606- Provider Type
- Individual Provider (NPI-1)
- Credentials
- PA
- Status
- Active
Contact & Location
- Address
- 7941 W RIFLEMAN ST, BOISE, ID, 837049001
- Phone
- (208) 895-7950
Specialties & Taxonomies
Physician Assistant
License: WA #PA61522965
Physician Assistant
Primary License: ID #PA-1715