Individual
JEREMY MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 336-0895
Mailing address
3240 BERMUDA ISLE CIR, APT 930, NAPLES, FL 34109-3214
(801) 608-4224
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
54460
ID
Other
Enumeration date
02/11/2017
Last updated
02/11/2017
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