Provider Demographics
NPI:1538101050
Name:BOYER, WENDI RENE (CRNA MNA)
Entity Type:Individual
Prefix:MRS
First Name:WENDI
Middle Name:RENE
Last Name:BOYER
Suffix:
Gender:F
Credentials:CRNA MNA
Other - Prefix:MRS
Other - First Name:WENDI
Other - Middle Name:RENE
Other - Last Name:LIEBHART, RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, MNA
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-476-5777
Mailing Address - Fax:208-476-5385
Practice Address - Street 1:301 CEDAR ST
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9029
Practice Address - Country:US
Practice Address - Phone:208-476-8030
Practice Address - Fax:208-476-5385
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006217367500000X
TXAP110148367500000X
IDRNA487A367500000X
IDRNA-487A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806104300Medicaid