Organization
RIVER OF NO RETURN ANESTHESIA
Active
Organization
RIVER OF NO RETURN ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CECIL T. JACKSON C.R.N.A. (CEO)
(208) 756-2429
Entity
Organization
Contact information
Practice address
203 S DAISY ST, SALMON, ID 83467
(208) 756-5600
Mailing address
42 WILD ROSE RD, SALMON, ID 83467-5277
(208) 756-2429
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-411
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8M665
BLUE CROSS OF IDAHO
ID
05
—
OTH000
—
ID
Enumeration date
06/09/2008
Last updated
06/09/2008
Update your record
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