Individual
DENISE LOUISE JANICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
(208) 338-1796
Mailing address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
(208) 338-1796
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N15758
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA542
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430079011
RAILROAD MEDICARE
ID
05
—
806480500
—
ID
Enumeration date
05/25/2006
Last updated
08/03/2016
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