Healthcare Provider Details

I. General information

NPI: 1649809534
Provider Name (Legal Business Name): GENESIS ANESTHESIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N BISHOP LN
CAREYWOOD ID
83809
US

IV. Provider business mailing address

PO BOX 255
BAYVIEW ID
83803-0255
US

V. Phone/Fax

Practice location:
  • Phone: 208-683-1179
  • Fax:
Mailing address:
  • Phone: 208-683-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. WENDY E MORLEY
Title or Position: ANESTHESIA GROUP OWNER, VICE PRESID
Credential: CRNA
Phone: 208-683-1178