Organization
RNBA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAND N BRACKEN CRNA (OWNER)
(719) 251-5122
Entity
Organization
Contact information
Practice address
1501 HILAND AVE, BURLEY, ID 83318-2688
(208) 525-2090
(208) 523-8978
Mailing address
1943 CRESTVIEW DR, MOSCOW, ID 83843-9657
(208) 525-2090
(208) 523-8978
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386616332
INDIVIDUAL NPI
ID
Enumeration date
02/21/2019
Last updated
04/09/2019
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