Healthcare Provider Details

I. General information

NPI: 1033470216
Provider Name (Legal Business Name): DAVID JOSEPH SWOPE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 CORONADO ST
IDAHO FALLS ID
83404-7552
US

IV. Provider business mailing address

7136 GREEN RIVER CIR
IDAHO FALLS ID
83406-1271
US

V. Phone/Fax

Practice location:
  • Phone: 208-421-1159
  • Fax:
Mailing address:
  • Phone: 208-421-1159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA-829A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: