Individual
STACY M SWEENEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
Mailing address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
R82265
OK
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-843A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200275020A
—
OK
Enumeration date
10/20/2009
Last updated
12/28/2016
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