Individual
VIKTOR LAVOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SRNA
Contact information
Practice address
2537 W STATE ST STE 200, BOISE, ID 83702-2200
(208) 593-2202
Mailing address
24009 WAGNER RD, CALDWELL, ID 83607-8801
(916) 220-2405
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
144619
ID
Other
Enumeration date
11/20/2020
Last updated
01/04/2023
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