Provider Demographics
NPI:1326440827
Name:BOZARTH, NICHOLAS WADE (PA-C)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:WADE
Last Name:BOZARTH
Suffix:
Gender:
Credentials:PA-C
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Mailing Address - Street 1:1101 E POLSTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6045
Mailing Address - Country:US
Mailing Address - Phone:208-747-1776
Mailing Address - Fax:208-747-1777
Practice Address - Street 1:8181 N CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8752
Practice Address - Country:US
Practice Address - Phone:208-770-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-2131363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical