Individual
MR. JACOB L CROSBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404
(866) 487-0277
(770) 701-6674
Mailing address
PO BOX 94289, MS 631130, SEATTLE, WA 98124-0618
(866) 487-0277
(770) 701-6676
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
14-103663-111
KS
163W00000X
Registered Nurse
501146-3102
UT
367500000X
Certified Registered Nurse Anesthetist
268930997
WY
367500000X
Certified Registered Nurse Anesthetist
55640
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
62128
ID
Other
Enumeration date
05/27/2008
Last updated
10/11/2019
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