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Grant Gundersen, CNRA
NPI 1467863829 · on the registry since 2014
Practice
- Address
- 646 W 300 S
Blackfoot, ID 83221 - Phone
- (208) 760-7529
Registry record
- Primary taxonomy
- 367500000X
367500000X
- Licence states on file
- ID
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2014-05-19
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho