Healthcare Provider Details

I. General information

NPI: 1922022482
Provider Name (Legal Business Name): ALAN D HOLT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 NORTH 100 EAST
PRESTON ID
83263
US

IV. Provider business mailing address

PO BOX 403
PRESTON ID
83263-0403
US

V. Phone/Fax

Practice location:
  • Phone: 208-852-0137
  • Fax:
Mailing address:
  • Phone: 208-523-4906
  • 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: ALAN D HOLT
Title or Position: OWNER
Credential: CRNA
Phone: 208-852-2709