Individual
KEELY CARDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNAP
Contact information
Practice address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
Mailing address
781 N SHADOWRIDGE AVE, EAGLE, ID 83616
(816) 529-2518
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
14-126679-032
KS
163W00000X
Registered Nurse
40228
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
55952
ID
Other
Enumeration date
04/30/2017
Last updated
10/04/2017
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