Individual
CHAD ROBERT MOMBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5810
(208) 814-1000
Mailing address
679 CREEKSIDE WAY, TWIN FALLS, ID 83301-4706
(435) 313-8678
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N-42963
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-813A
ID
Other
Enumeration date
10/14/2011
Last updated
10/14/2011
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