Provider Demographics
NPI:1619294303
Name:INLAND NORTHWEST ANESTHESIA PLLC
Entity Type:Organization
Organization Name:INLAND NORTHWEST ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-667-1376
Mailing Address - Street 1:850 W IRONWOOD DR
Mailing Address - Street 2:STE 300
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4903
Mailing Address - Country:US
Mailing Address - Phone:208-667-1376
Mailing Address - Fax:208-292-0873
Practice Address - Street 1:850 W IRONWOOD DR
Practice Address - Street 2:STE 300
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4903
Practice Address - Country:US
Practice Address - Phone:208-667-1376
Practice Address - Fax:208-292-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA570367500000X
IDRNA595367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty