Organization
SUNRISE KETAMINE CLINIC LLC
Active
Organization
SUNRISE KETAMINE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN TODD MERKLEY CRNA (OWNER)
(208) 520-0527
Entity
Organization
Contact information
Practice address
3555 POTOMAC WAY STE B, IDAHO FALLS, ID 83404-4985
(208) 524-9080
(208) 529-3786
Mailing address
3555 POTOMAC WAY STE B, IDAHO FALLS, ID 83404-4985
(208) 524-9080
(208) 529-3786
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
10/06/2021
Last updated
10/06/2021
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