Individual
JEREMY CHARLES BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
Mailing address
1847 W WHITESTONE CT, MERIDIAN, ID 83646-1308
(208) 680-5168
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
41433
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-892A
ID
Other
Enumeration date
11/08/2013
Last updated
01/17/2020
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