Healthcare Provider Details

I. General information

NPI: 1972743359
Provider Name (Legal Business Name): ROBERT DUNCAN OLSON RN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DUNCAN OLSON RN, CRNA

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 12/12/2012
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

338 E BANNOCK ST
BOISE ID
83712-6207
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-2222
  • Fax:
Mailing address:
  • Phone: 208-336-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR172566-9
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNP-1235A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: