Individual
JACOB SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-4000
Mailing address
101 W IRONWOOD DR STE D, COEUR D ALENE, ID 83814-1409
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
9471892
ID
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
ID
Other
Enumeration date
12/18/2025
Last updated
01/17/2026
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