Healthcare Provider Details

I. General information

NPI: 1629643473
Provider Name (Legal Business Name): GUY STEVEN PLAHN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK ST
BOISE ID
83712-6241
US

IV. Provider business mailing address

910 W PUEBLO ST
BOISE ID
83702-4247
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-2222
  • Fax:
Mailing address:
  • Phone: 208-371-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberLRT-483
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: