| NPI | 1992706840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH R. PETERSEN CEO 208-677-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2017-08-17 |