Individual
MR. MICAH SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1000
Mailing address
PO BOX 4107, POCATELLO, ID 83205-4107
(208) 233-8880
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-873A
ID
390200000X
Student in an Organized Health Care Education/Training Program
201040817RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699078535
—
ID
Enumeration date
12/15/2010
Last updated
02/23/2016
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