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General NPI Number Information
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NPI Number | 1558681502
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Entity Type | Individual
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Provider Name | DUSTIN PAUL GILL
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Gender | Male
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 804 S WASHINGTON ST STE A
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City | MOSCOW
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State | ID
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Zip | 83843-3182
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Country | US
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Telephone | 208-883-6700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8007
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City | MOSCOW
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State | ID
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Zip | 83843-0507
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Country | US
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Telephone | 208-883-2224
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Fax | 208-883-6580
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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 | 56753
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License Number State | ID
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