Individual
JORDAN THOMAS TAIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
2537 W STATE ST STE 200, BOISE, ID 83702-2200
(208) 336-0895
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
59764
ID
Other
Enumeration date
08/31/2018
Last updated
05/01/2019
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