| NPI | 1902208085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY RHENE GARDNER Principle 208-286-0137 |
| Organization Subpart ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 2120) |
| Enumeration Date | 2014-09-21 |
| Last Update Date | 2014-09-21 |