Individual
MR. WALTER JESSE TRUDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(479) 659-2746
Mailing address
343 SUNTERRA DR, IDAHO FALLS, ID 83404-5089
(479) 659-2746
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 0090514
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704251198
ANESTHESIOLOGY
MI
Enumeration date
05/17/2006
Last updated
11/17/2016
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