Healthcare Provider Details

I. General information

NPI: 1093762569
Provider Name (Legal Business Name): GARRET MYHAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MAPLE AVE STE 503
SPRINGDALE AR
72764-5376
US

IV. Provider business mailing address

PO BOX 583
LOWELL AR
72745-0583
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-3722
  • Fax: 479-751-1099
Mailing address:
  • Phone: 479-751-3722
  • Fax: 479-751-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC01576 CRNA
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: