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MARIA C BODE CRNA

>> Anesthesiology >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1821003781

Individual Registrant:
 MARIA C BODE CRNA
Gender: F
Not Sole Proprietor

Location and contact information for practice:
700 S MAIN ST  MOSCOW, ID 83843-3056 US
Tel: 208-883-6350  Fax: --

Contact information for business:
700 S MAIN ST  MOSCOW, ID 83843-3056 US
Tel: 208-883-6350  Fax: --

Registration Information:
NPI: 1821003781
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207L00000XAllopathic & Osteopathic Physicians
Anesthesiology
IDN28761

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
807575400ID05
KANSAS LICENSE14-93064-111KS01
9650516WA05
BC IDA4598ID01
IDAHO LICENSEN28761ID01
RAILROAD MEDICAREP0035794601
RR MEDICAREP00357946ID01




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