Individual
BRIAN CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8552 N GOVERNMENT WAY, HAYDEN, ID 83835-9280
(208) 772-7600
Mailing address
8552 N GOVERNMENT WAY, HAYDEN, ID 83835-9280
(208) 772-7600
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
RN60272088
WA
367500000X
Certified Registered Nurse Anesthetist
Primary
57988
ID
367500000X
Certified Registered Nurse Anesthetist
AP60872413
WA
Other
Enumeration date
05/31/2018
Last updated
10/31/2024
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