Individual
SPENCER D STUCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
351 SW 9TH ST, ONTARIO, OR 97914-2639
(541) 881-7000
Mailing address
PO BOX 2936, IDAHO FALLS, ID 83403-2936
(208) 552-8773
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
201360025CRNA
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518100759
—
ID
05
—
1518100759
—
OR
Enumeration date
04/17/2009
Last updated
03/17/2018
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