Individual
GRANT GUNDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNRA
Contact information
Practice address
646 W 300 S, BLACKFOOT, ID 83221-6334
(208) 760-7529
Mailing address
646 W 300 S, BLACKFOOT, ID 83221-6334
(208) 760-7529
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
N-38994
ID
Other
Enumeration date
05/19/2014
Last updated
05/19/2014
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