Individual
MR. DAVID S MICKLITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
111 W STATE ST, BOISE, ID 83702-6127
(208) 336-0895
(208) 338-1796
Mailing address
111 W STATE ST, BOISE, ID 83702-6127
(208) 336-0895
(208) 338-1796
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA505
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80613340
—
ID
Enumeration date
08/11/2006
Last updated
07/09/2007
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