Individual
MR. BRUCE WILLIAM DEMKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
30544 HIGHWAY 200, PONDERAY, ID 83852-5005
(208) 255-8013
Mailing address
PO BOX 591, SAGLE, ID 83860
(208) 265-3534
(208) 265-3534
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
N30209
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA491A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805855300
—
ID
Enumeration date
03/01/2006
Last updated
04/13/2012
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