Organization
LAKESIDE ANESTHESIA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORRAINE GRANFIELD CRNA (BUSINESS OWNER)
(772) 285-3457
Entity
Organization
Contact information
Practice address
520 N THIRD AVE, SANDPOINT, ID 83864-1507
(208) 263-1441
Mailing address
PO BOX 591, SAGLE, ID 83860-0591
(208) 265-3534
(208) 265-3534
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-671
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APPLYING
APPLYING FOR ALL PROVIDER NUMBERS
ID
Enumeration date
05/14/2009
Last updated
05/14/2009
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