Healthcare Provider Details

I. General information

NPI: 1144319849
Provider Name (Legal Business Name): MICHAEL R THYGERSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 S HOSPITAL DR
GLOBE AZ
85501-9447
US

IV. Provider business mailing address

PO BOX 386
GLOBE AZ
85502-0386
US

V. Phone/Fax

Practice location:
  • Phone: 928-961-3902
  • Fax:
Mailing address:
  • Phone: 928-961-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number286558-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: