Organization
ADVANCED ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DORIAN S. GRUNIG CRNA (PRESIDENT)
(208) 390-7757
Entity
Organization
Contact information
Practice address
1155 POCATELLO CREEK RD, POCATELLO, ID 83201-2949
(208) 238-6337
Mailing address
115 CANYON RD, MONTPELIER, ID 83254-1218
(208) 390-7757
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA613A
—
Other
Enumeration date
04/06/2018
Last updated
04/06/2018
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