Healthcare Provider Details

I. General information

NPI: 1528309697
Provider Name (Legal Business Name): JODY M KRAGER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S DOBSON RD
CHANDLER AZ
85224-5710
US

IV. Provider business mailing address

891 E PEACH TREE PL
CHANDLER AZ
85249-5609
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-9800
  • Fax: 480-899-2994
Mailing address:
  • Phone: 480-899-9800
  • Fax: 480-899-2994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberMNCRNA2140
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0919
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: