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General NPI Number Information
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NPI Number | 1881966885
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Entity Type | Individual
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Provider Name | ERIC LEON BAILEY CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 801 POLE LINE RD W MAGIC VALLEY ANESTHESIOLOGY ASSOCIATES
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City | TWIN FALLS
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State | ID
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Zip | 83301-5810
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Country | US
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Telephone | 208-358-2810
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Fax | 208-814-2921
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Provider Business Mailing Address
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Address Line | 1372 VALENCIA ST
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City | TWIN FALLS
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State | ID
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Zip | 83301-5581
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Country | US
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Telephone | 208-731-0873
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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 | RNA-823A
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License Number State | ID
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