Individual
JAXON DEAN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2325 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 557-2700
Mailing address
PO BOX 4268, PORTLAND, OR 97208-4268
(503) 372-2740
(503) 372-2754
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N-36657
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
847A
ID
Other
Enumeration date
08/28/2012
Last updated
07/21/2022
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