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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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