Healthcare Provider Details

I. General information

NPI: 1710091533
Provider Name (Legal Business Name): ROBERT DENHOLM CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 NORTHWAY DR.
ANCHORAGE AK
99508
US

IV. Provider business mailing address

ALASKA SURGERY CENTER 1230 NORTHWAY DRIVE
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-550-6100
  • Fax: 402-343-8765
Mailing address:
  • Phone: 907-550-6100
  • Fax: 402-343-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100700
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNURA442
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: