Individual
JON F CHAMPLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1945 E 17TH ST, IDAHO FALLS, ID 83404-6429
(208) 529-1945
Mailing address
PO BOX 52180, IDAHO FALLS, ID 83405-2180
(208) 523-4906
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA328A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P0015576
RAILROAD MEDICARE
—
Enumeration date
11/02/2006
Last updated
12/21/2007
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