Healthcare Provider Details

I. General information

NPI: 1275855066
Provider Name (Legal Business Name): DREAM ON ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SW 9TH ST
ONTARIO OR
97914-2639
US

IV. Provider business mailing address

PO BOX 2642
IDAHO FALLS ID
83403-2642
US

V. Phone/Fax

Practice location:
  • Phone: 541-881-7146
  • Fax:
Mailing address:
  • Phone: 208-552-8774
  • Fax: 208-523-2025

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: MR. JAMES L HEYREND
Title or Position: MEMBER
Credential: CRNA
Phone: 208-740-4134