Individual
BRENDAN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5810
(208) 814-1000
Mailing address
2405 INDEPENDENCE ST, TWIN FALLS, ID 83301
(480) 734-4071
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-844A
ID
Other
Enumeration date
09/05/2012
Last updated
11/20/2012
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