Provider Demographics
NPI:1750809265
Name:DREAMWORKS ANESTHESIA PC
Entity type:Organization
Organization Name:DREAMWORKS ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNNS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:423-883-2821
Mailing Address - Street 1:190 STILLWATER DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8296
Mailing Address - Country:US
Mailing Address - Phone:423-883-2821
Mailing Address - Fax:208-881-5351
Practice Address - Street 1:1855 MADISON AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-1212
Practice Address - Country:US
Practice Address - Phone:208-881-5351
Practice Address - Fax:208-881-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty