MEDICARE: TIMOTHY PHAN 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
1	367500000X	Certified Registered Nurse Anesthetist	CRNA000265	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417949314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY PHAN CRNA

Provider Business Mailing Address
First Line	:	7385 S PECOS RD
Second Line	:	STE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3768
Country	:	US
Telephone Number	:	888-221-2297
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 S LOLA LN
Second Line	:	SUITE 200
City	:	PAHRUMP
State	:	NV
Zip	:	89048-0878
Country	:	US
Telephone Number	:	775-751-7500
Fax Number	:	775-751-7824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	12/20/2016

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Directions to “ TIMOTHY PHAN CRNA” Practice Location

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