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General NPI Number Information
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NPI Number | 1912985755
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Entity Type | Individual
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Provider Name | DAVID NICHOLSON C.R.N.A.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 1055 N CURTIS RD
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City | BOISE
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State | ID
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Zip | 83706-1309
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Country | US
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Telephone | 208-367-6416
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Fax | 208-367-2742
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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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 | R48739
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License Number State | NM
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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 | CRNA00752
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NA95000124
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 59928
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License Number State | ID
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