Individual
JOSHUA J MACKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
(208) 338-1796
Mailing address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
(208) 338-1796
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA755
ID
Other
Enumeration date
07/09/2009
Last updated
07/09/2009
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