Individual
JARON KIRK POLATIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-6264
Mailing address
140 N BASSETT RD, IDAHO FALLS, ID 83402-5665
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
9273443-3102
UT
367500000X
Certified Registered Nurse Anesthetist
Primary
63244
ID
Other
Enumeration date
12/12/2019
Last updated
01/17/2020
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