Individual
SHAWN A WREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221
(208) 785-4100
Mailing address
PO BOX 1627, IDAHO FALLS, ID 83403-1627
(208) 552-8778
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
59106
ID
367500000X
Certified Registered Nurse Anesthetist
CRNA-01479
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922530062
—
ID
Enumeration date
03/29/2017
Last updated
07/30/2018
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