Healthcare Provider Details

I. General information

NPI: 1548588783
Provider Name (Legal Business Name): CHRISTOPHER WAYNE THEODORE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WERNER ST. JOSEPH HOSPITAL
HOT SPRINGS AR
71913-6921
US

IV. Provider business mailing address

3810 CENTRAL AVENUE, SUITE H MIDSTATE MEDICAL SERVICES
HOT SPRINGS AR
71913-6921
US

V. Phone/Fax

Practice location:
  • Phone: 501-622-1875
  • Fax: 501-525-1925
Mailing address:
  • Phone: 501-525-5840
  • Fax: 501-525-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number#R72957
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number#CTP000134
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: