Healthcare Provider Details

I. General information

NPI: 1558042176
Provider Name (Legal Business Name): MURIELLE FLAVIE KAMENI KETCHANDJI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 E TANGERINE RD
ORO VALLEY AZ
85755-6213
US

IV. Provider business mailing address

3335 LEGENDS SHADOW DR
SPRING TX
77386-6008
US

V. Phone/Fax

Practice location:
  • Phone: 520-901-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1129241
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4059740
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: