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Individual

BLAKE G PURCELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1485 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-5100
Mailing address
PO BOX 2193, IDAHO FALLS, ID 83403-2193
(208) 552-8762

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA52
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1063590107
ID
Enumeration date
11/02/2006
Last updated
09/19/2017
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