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NPI Code Detail

MEDICARE: JEREMY HENRIE CRNA

MEDICARE: JEREMY HENRIE CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist8380193-3102UT
2367500000XCertified Registered Nurse Anesthetist329019AZ

General Provider Information

NPI Number : 1356886832
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY HENRIE CRNA
Provider Business Mailing Address
First Line : 10660 S REMBRANDT LN
Second Line :
City : SANDY
State : UT
Zip : 84070-5224
Country : US
Telephone Number : 804-594-2622
Fax Number : 804-594-0915
Provider Business Practice Location Address
First Line : 6200 N LA CHOLLA BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85741-3529
Country : US
Telephone Number : 520-742-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2016
Last Update Date : 12/05/2025

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Directions to “ JEREMY HENRIE CRNA” Practice Location

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