Individual
DIANA SAN JUAN SHIMKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1352
(208) 367-6416
Mailing address
6397 S OLIVE ST, CENTENNIAL, CO 80111-4632
(407) 616-0295
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA664
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807528800
—
ID
Enumeration date
06/07/2006
Last updated
06/06/2012
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