Individual
DENNIS C MACIESKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2325 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 552-2700
Mailing address
PO BOX 3206, IDAHO FALLS, ID 83403-3206
(208) 523-4609
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
N-18888
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004378000
—
ID
Enumeration date
06/27/2006
Last updated
07/12/2007
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