Individual
TREVOR LEE DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA, MHS
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-6264
Mailing address
PO BOX 1891, IDAHO FALLS, ID 83403-1891
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN-38983
ID
Other
Enumeration date
09/19/2014
Last updated
10/01/2015
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