Individual
MR. BRIAN BLAKE PURCELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1485 PARKWAY DR, BLACKFOOT, ID 83221-1667
(208) 785-5100
Mailing address
PO BOX 2193, IDAHO FALLS, ID 83403-2193
(208) 552-8777
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
N42090
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-937A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801273321
—
ID
Enumeration date
05/05/2015
Last updated
12/09/2016
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