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General NPI Number Information
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NPI Number | 1023582947
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Entity Type | Individual
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Provider Name | KENNETH CLARK STRATTON JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 01/14/2019
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Provider Practice Location Address
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Address Line | 1055 N CURTIS RD
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City | BOISE
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State | ID
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Zip | 83706-1309
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Country | US
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Telephone | 208-367-2559
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3750
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City | SALT LAKE CITY
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State | UT
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Zip | 84110-3750
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 60377
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License Number State | ID
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