Individual
JOHN P GOEDDERTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-2163
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 302-9342
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
R26650
ND
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-694
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12462
—
ND
Enumeration date
01/19/2007
Last updated
10/09/2023
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