Healthcare Provider Details

I. General information

NPI: 1295215416
Provider Name (Legal Business Name): WILLIAM GARRETT RYAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S CRISMON RD
MESA AZ
85209-3767
US

IV. Provider business mailing address

1925 S CORONADO RD APT 1056
GILBERT AZ
85295-2204
US

V. Phone/Fax

Practice location:
  • Phone: 480-358-6100
  • Fax:
Mailing address:
  • Phone: 801-557-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1550
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: