Healthcare Provider Details

I. General information

NPI: 1497176689
Provider Name (Legal Business Name): JOSEPH ROMERO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2013
Last Update Date: 12/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK ST
BOISE ID
83712-6241
US

IV. Provider business mailing address

2135 1/2 W STATE ST
BOISE ID
83702-3844
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-2222
  • Fax:
Mailing address:
  • Phone: 208-598-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA-885A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: