Individual
JASON D MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 765-8585
(208) 765-8486
Mailing address
2204 IRONWOOD PL STE B, COEUR D ALENE, ID 83814-2662
(208) 765-8585
(208) 765-8486
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
22689
MT
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-709A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912120551
—
ID
05
—
1912120551
—
MT
Enumeration date
04/11/2007
Last updated
04/29/2024
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