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Eleanor Rose Wilson

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

100 E Idaho St Ste 302, Boise, ID 83712-6269

PECOS Enrollment

This provider is enrolled in PECOS as ELEANOR WILSON.

Based on the most recent information from CMS, provider Eleanor Rose Wilson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1336871623
Provider Type
Individual
Full Name
Wilson, Eleanor Rose
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
6/27/2022
Last Updated
7/28/2025

Contact Information

Practice Location

100 E Idaho St Ste 302, Boise, ID 83712-6269

(208) 343-7501

Unlisted Fax

Mailing Location

190 E Bannock St, Boise, ID 83712-6241

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA-2592 Idaho

Eleanor Rose Wilson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Gorham, Amber Zoe

Meziere, Lauren

Talford, David B

Hurty, Michelle R

Chism, Sarah

Baggs, Jacqueline

Nielson, David E

Joly, Celeste

Lynn, Michael Brian

Davis, Brittney