Healthcare Provider Details

I. General information

NPI: 1265847065
Provider Name (Legal Business Name): CHAD BOESL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 E BASELINE RD STE 109-180
MESA AZ
85209-8310
US

IV. Provider business mailing address

9221 E BASELINE RD STE 109-180
MESA AZ
85209-8310
US

V. Phone/Fax

Practice location:
  • Phone: 509-863-3939
  • Fax:
Mailing address:
  • Phone: 509-863-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number141150
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number741032
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number195491
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: