Individual
SHAD B WESTOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1717 ARLINGTON AVE, CALDWELL, ID 83605-4802
(208) 455-4009
Mailing address
PO BOX 3816, IDAHO FALLS, ID 83403-3816
(208) 552-8572
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
NA3614
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA714
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8079285
—
ID
Enumeration date
12/31/2007
Last updated
02/28/2017
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