Healthcare Provider Details

I. General information

NPI: 1770701492
Provider Name (Legal Business Name): SCOTT R SCHALKLE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5931 E SIERRA MORENA ST
MESA AZ
85215-7802
US

IV. Provider business mailing address

5931 E SIERRA MORENA ST
MESA AZ
85215-7802
US

V. Phone/Fax

Practice location:
  • Phone: 602-509-5353
  • Fax: 480-419-7553
Mailing address:
  • Phone: 602-509-5353
  • Fax: 480-419-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN074139
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: