| NPI | 1720687031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY L BAUER Practice Manager 208-691-1901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2020-10-19 |