Provider Demographics
NPI:1790224905
Name:RAFLA, YUSTINA NADER (PA-C)
Entity Type:Individual
Prefix:
First Name:YUSTINA
Middle Name:NADER
Last Name:RAFLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 S PORTSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6300
Mailing Address - Country:US
Mailing Address - Phone:208-921-1910
Mailing Address - Fax:
Practice Address - Street 1:520 S EAGLE RD STE 1243
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6355
Practice Address - Country:US
Practice Address - Phone:208-333-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant