Individual
DR. BRENNA HISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
Mailing address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A98935
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
A98935
CA
Other
Enumeration date
05/05/2009
Last updated
08/29/2011
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