Individual
JACOB L. LUFKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
164 S 5TH ST, MONTPELIER, ID 83254-1597
(208) 847-1630
Mailing address
123 VALLEY VIEW DR, MONTPELIER, ID 83254-1529
(208) 604-5009
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28219682A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
57248
ID
Other
Enumeration date
02/02/2015
Last updated
03/23/2020
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