NPI age
19 years
Enumerated 2006-08-07
Across 575 active nurse anesthetist, certified registered providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (MT) | 32452 | STATE LICENSE NUMBER |
| 01 (ID) | RNA-623 | STATE LICENSE NUMBER |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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