Individual
MATTHEW L MONROE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
Mailing address
PO BOX 829, BLACKFOOT, ID 83221-0829
(208) 523-4906
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA649
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00313841
RAILROAD MEDICARE
—
Enumeration date
10/19/2006
Last updated
12/21/2007
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