Healthcare Provider Details

I. General information

NPI: 1982347530
Provider Name (Legal Business Name): JORDAN BOHRER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD
MESA AZ
85202-4707
US

IV. Provider business mailing address

7301 N 16TH ST STE 102
PHOENIX AZ
85020-5266
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-3000
  • Fax:
Mailing address:
  • Phone: 804-204-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number322179
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: