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General NPI Number Information
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NPI Number | 1407031180
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Entity Type | Individual
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Provider Name | SHAD B WESTOVER CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 1717 ARLINGTON AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4802
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Country | US
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Telephone | 208-455-4009
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3816
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City | IDAHO FALLS
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State | ID
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Zip | 83403-3816
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Country | US
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Telephone | 208-552-8572
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Fax | 208-523-2025
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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 | RNA714
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NA3614
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License Number State | CA
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