Healthcare Provider Details

I. General information

NPI: 1326454422
Provider Name (Legal Business Name): HAPPY ZONE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N LIBERTY ST
BOISE ID
83704-8703
US

IV. Provider business mailing address

1601 E 17TH STREET
IDAHO FALLS ID
83404
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-4522
  • Fax:
Mailing address:
  • Phone: 208-525-2090
  • Fax: 208-523-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA462
License Number StateWY

VIII. Authorized Official

Name: MICHAEL P GARRETT
Title or Position: OWNER
Credential: CRNA
Phone: 208-794-0159