Organization
MOCK ANESTHESIA
Active
Organization
MOCK ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE L CROFT CPC (BILLING MANAGER)
(208) 525-2090
Entity
Organization
Contact information
Practice address
1720 WYOMING BLVD NE, ALBUQUERQUE, NM 87112-3855
(505) 721-7200
Mailing address
PO BOX 2823, IDAHO FALLS, ID 83403-2823
(208) 525-2090
(208) 523-8978
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN-76102
NM
Other
Enumeration date
03/06/2017
Last updated
03/06/2017
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