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General NPI Number Information
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NPI Number | 1639535792
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Entity Type | Individual
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Provider Name | ANITA MARIE GORIUP R.EEGT.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 3100 CHANNING WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7533
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Country | US
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Telephone | 208-529-6147
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Fax |
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Provider Business Mailing Address
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Address Line | 2173 CALICO DR
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City | IDAHO FALLS
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State | ID
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Zip | 83402-2369
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Country | US
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Telephone | 208-589-4210
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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 | 2472E0500X
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Taxonomy Name | EEG Technician
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License Number |
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License Number State |
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