Organization
KETAMINE INFUSIONS OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA STUBBS CRNA (OWNER)
(208) 607-8401
Entity
Organization
Contact information
Practice address
1582 ELK CREEK DR, IDAHO FALLS, ID 83404-8322
(208) 607-8401
Mailing address
PO BOX 3646, IDAHO FALLS, ID 83403-3646
(208) 607-8401
(208) 534-5838
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
04/09/2021
Last updated
04/09/2021
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