Individual
MR. CLINT LEVI HURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
338 E BANNOCK ST, BOISE, ID 83712-6207
(208) 336-0895
Mailing address
2887 NW 13TH ST, MERIDIAN, ID 83646-3166
(801) 725-7075
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN669787
PA
367500000X
Certified Registered Nurse Anesthetist
57261
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
70178714406
UT
367500000X
Certified Registered Nurse Anesthetist
70178718901
UT
Other
Enumeration date
11/20/2017
Last updated
08/23/2023
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