Individual
RYAN EARL WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RNA
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-6416
Mailing address
PO BOX 4268, PORTLAND, OR 97208-4268
(503) 372-2740
(503) 372-2754
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N29645
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA708
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807874600
—
ID
01
—
807874603
MEDICAID - WVMC
ID
Enumeration date
07/13/2007
Last updated
04/08/2011
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