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General NPI Number Information
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NPI Number | 1174925135
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Entity Type | Individual
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Provider Name | HEATHER ANDERSON CST
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Gender | Female
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 1736 S MILLENIUM WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1511
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Country | US
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Telephone | 208-344-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 15 S RUBY ST
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City | BOISE
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State | ID
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Zip | 83706-2858
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Country | US
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Telephone | 208-396-9207
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 122712
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License Number State | ID
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