Individual
BRYAN WILLIAM LEUENHAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1352
(208) 367-6416
Mailing address
PO BOX 741114, CHICAGO, IL 60674-0001
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N31597
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA538
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806473500
—
ID
Enumeration date
05/26/2006
Last updated
09/29/2023
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