Healthcare Provider Details

I. General information

NPI: 1093730434
Provider Name (Legal Business Name): CRAIG RYAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W FRYE RD
CHANDLER AZ
85224-6282
US

IV. Provider business mailing address

6930 E TETON CIR
MESA AZ
85207-0939
US

V. Phone/Fax

Practice location:
  • Phone: 480-728-3000
  • Fax:
Mailing address:
  • Phone: 480-924-7829
  • Fax: 480-924-7829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0265
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: