Individual
MR. CHRIS CHADWICK FUGATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
256 N 2ND E, REXBURG, ID 83440-1638
(208) 656-9646
Mailing address
PO BOX 3659, IDAHO FALLS, ID 83403-3659
(208) 525-2090
(208) 525-2662
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
N-16877
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0043670
—
ID
Enumeration date
11/09/2006
Last updated
11/10/2020
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