Healthcare Provider Details

I. General information

NPI: 1528065117
Provider Name (Legal Business Name): MICHAEL PRYOR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E FLORENCE BLVD
CASA GRANDE AZ
85222-4764
US

IV. Provider business mailing address

PO BOX 29211
PHOENIX AZ
85038-9211
US

V. Phone/Fax

Practice location:
  • Phone: 602-273-6770
  • Fax: 602-889-0489
Mailing address:
  • Phone: 602-273-6770
  • Fax: 602-889-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN077074
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: