| Doctor Name: | SIS E OSTOLASA |
| NPI Number: | 1013952761 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | PA386 |
| Business Practice Address: | 381 S Middleton Rd Ste B Middleton, ID - 836445369 |
| Business Phone Number: | 2085856311 |
| Business Fax Number: | 2085856221 |
| Mailing Address: | 381 S Middleton Rd Ste B, MIDDLETON |
| State: | ID |
| Postal Code: | 836445369 |
| Phone Number: | 2085856311 |
| Fax Number: | 2085856221 |
| NPI Enumeration Date: | 06/17/2006 |
| NPI Last Update Date: | 01/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA386 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |