Individual
JEFFERY CARL RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA-DNP
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(801) 231-9869
Mailing address
2808 N RICHARD DR, LA CROSSE, WI 54601-8032
(801) 231-9869
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
241081-30
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
68470
ID
Other
Enumeration date
05/26/2021
Last updated
07/19/2021
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