Organization
BLUE LAKES ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THAD HOLLIST CRNA (MANAGING MEMBER)
(208) 520-0035
Entity
Organization
Contact information
Practice address
2092 DAWSON DR, TWIN FALLS, ID 83301-3195
(208) 734-7362
Mailing address
3849A N 3700 E, HANSEN, ID 83334-5039
(208) 734-7362
(208) 733-9463
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
08/13/2024
Last updated
08/21/2024
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