Individual
MICHAEL SCOTT MICKELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 390-1648
Mailing address
413 N 4370 E, RIGBY, ID 83442-4929
(208) 390-1648
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-783
ID
Other
Enumeration date
01/25/2011
Last updated
01/25/2011
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