Individual
FORREST READ PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
3777 NW CAROLYN PL, MOUNTAIN HOME, ID 83647-5498
(208) 477-4736
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
40402
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
60550
ID
Other
Enumeration date
01/09/2019
Last updated
01/24/2019
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