Individual
CODY WADE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-6416
Mailing address
PO BOX 4008, PORTLAND, OR 97208-4008
(503) 372-2740
(503) 372-2754
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA 768
ID
Other
Enumeration date
01/12/2010
Last updated
03/03/2010
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