Individual
MR. TODD EDWARD KOERNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2325 CORONADO ST., IDAHO FALLS, ID 83404
(812) 237-0211
Mailing address
2325 CORONADO ST., IDAHO FALLS, ID 83404
(812) 877-9493
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28158908A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200459230
—
IN
Enumeration date
07/11/2005
Last updated
11/17/2022
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