Individual
RUSSELL ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
115 FALLS AVE W, TWIN FALLS, ID 83301-3115
(208) 733-1662
(208) 733-9463
Mailing address
3075 N 3422 E, KIMBERLY, ID 83341-5362
(801) 458-7624
(208) 733-9463
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
55818
ID
367500000X
Certified Registered Nurse Anesthetist
CRNA-01284
NM
Other
Enumeration date
11/22/2013
Last updated
03/17/2018
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