Healthcare Provider Details

I. General information

NPI: 1659308831
Provider Name (Legal Business Name): BRUCE N BJORNSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CHANNING WAY
IDAHO FALLS ID
83404-7533
US

IV. Provider business mailing address

255 W MICHIGAN AVE
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-6269
  • Fax:
Mailing address:
  • Phone: 866-570-0077
  • Fax: 248-479-0652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberN-17358
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: