Healthcare Provider Details

I. General information

NPI: 1093894107
Provider Name (Legal Business Name): LINDA M EVANS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E MALLARD DR SUITE 125
BOISE ID
83706-6644
US

IV. Provider business mailing address

PO BOX 3207
IDAHO FALLS ID
83403-3207
US

V. Phone/Fax

Practice location:
  • Phone: 208-336-8700
  • Fax:
Mailing address:
  • Phone: 208-525-2090
  • Fax: 208-525-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberN-23688
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: