Provider Demographics
NPI:1730916305
Name:CYR, BRETTA LEE (PA)
Entity type:Individual
Prefix:
First Name:BRETTA
Middle Name:LEE
Last Name:CYR
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3167 W BELLTOWER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4066
Mailing Address - Country:US
Mailing Address - Phone:208-908-7797
Mailing Address - Fax:208-908-6588
Practice Address - Street 1:3167 W BELLTOWER DR STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4066
Practice Address - Country:US
Practice Address - Phone:208-908-7797
Practice Address - Fax:208-908-6588
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2025-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ID3361970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant