Individual
TRAVIS HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1717 ARLINGTON AVE, CALDWELL, ID 83605-4802
(208) 459-4641
Mailing address
6452 E SHELLBROOK DR, NAMPA, ID 83687-4126
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
41135
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
112038
ID
Other
Enumeration date
11/18/2016
Last updated
09/13/2024
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