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General NPI Number Information
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NPI Number | 1982610549
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Entity Type | Individual
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Provider Name | DORIAN S GRUNIG CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 164 SOUTH 5TH
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City | MONTPELIER
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State | ID
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Zip | 83254
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Country | US
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Telephone | 208-390-7757
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Fax | 208-847-4425
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Provider Business Mailing Address
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Address Line | 457 NORTH 10TH STREET
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City | MONTPELIER
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State | ID
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Zip | 83254
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Country | US
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Telephone | 208-847-0401
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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 | RNA613A
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License Number State | ID
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