Healthcare Provider Details

I. General information

NPI: 1386378271
Provider Name (Legal Business Name): BRIANDA RASCON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 E ELWOOD ST STE 500
PHOENIX AZ
85040-1978
US

IV. Provider business mailing address

4605 E ELWOOD ST STE 500
PHOENIX AZ
85040-1978
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-1518
  • Fax: 480-304-3446
Mailing address:
  • Phone: 480-256-1518
  • Fax: 480-304-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN181819
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: