Individual
MARK ALAN PENDLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(082) 391-0562
(208) 239-3626
Mailing address
PO BOX 558, RIGBY, ID 83442-0558
(307) 248-0283
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
130808
ID
Other
Enumeration date
02/13/2020
Last updated
05/19/2020
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