Individual
GAVIN BRUDERER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA, MSNA
Contact information
Practice address
1717 ARLINGTON AVE, CALDWELL, ID 83605-4802
(208) 459-4641
Mailing address
17654 N NEWDALE AVE, NAMPA, ID 83687-4819
(208) 709-2425
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
11277587-3102
UT
367500000X
Certified Registered Nurse Anesthetist
Primary
57794
ID
Other
Enumeration date
08/03/2023
Last updated
09/16/2024
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