Provider Demographics
NPI:1023624129
Name:ROWLETTE, WESLEY J (PA-C)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:J
Last Name:ROWLETTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1209 N SUMMERBROOK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8750
Mailing Address - Country:US
Mailing Address - Phone:208-938-5823
Mailing Address - Fax:208-938-5306
Practice Address - Street 1:1209 N SUMMERBROOK AVE STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8750
Practice Address - Country:US
Practice Address - Phone:208-938-5823
Practice Address - Fax:208-938-5306
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-2613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant