Provider Demographics
NPI:1285677278
Name:ZEITZ, LOREN KEN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:KEN
Last Name:ZEITZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JACOBS GULCH
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837
Mailing Address - Country:US
Mailing Address - Phone:208-784-1221
Mailing Address - Fax:208-786-7019
Practice Address - Street 1:25 JACOBS GULCH
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837
Practice Address - Country:US
Practice Address - Phone:208-784-1221
Practice Address - Fax:208-786-1019
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA68207L00000X
IDN-10526367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN-10526OtherIDAHO LICENSE
ID8040130300Medicaid
ID1602829Medicare Oscar/Certification