Healthcare Provider Details

I. General information

NPI: 1689629784
Provider Name (Legal Business Name): TROY BRITTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E IDAHO ST SUITE 303
BOISE ID
83712-6212
US

IV. Provider business mailing address

1601 E 17TH ST
IDAHO FALLS ID
83404-6313
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-5757
  • 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 NumberRNA-83
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: