Healthcare Provider Details

I. General information

NPI: 1851120125
Provider Name (Legal Business Name): CONNOR LIVINGSTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
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

2221 LAKESIDE BLVD STE 600
RICHARDSON TX
75082-4416
US

V. Phone/Fax

Practice location:
  • Phone: 602-200-9021
  • Fax:
Mailing address:
  • Phone: 435-313-2738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11291775-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number312089
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: