Healthcare Provider Details

I. General information

NPI: 1023072121
Provider Name (Legal Business Name): CHRISTOPHER BROOKS CRNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 E CLARK DR
GILBERT AZ
85297-3133
US

IV. Provider business mailing address

2485 E CLARK DR
GILBERT AZ
85297-3133
US

V. Phone/Fax

Practice location:
  • Phone: 623-204-9191
  • Fax:
Mailing address:
  • Phone: 623-204-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN078229
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: