Healthcare Provider Details

I. General information

NPI: 1578181186
Provider Name (Legal Business Name): EMILY ANN TREFFERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ANN KASSMAN

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W THOMAS RD
PHOENIX AZ
85037-3332
US

IV. Provider business mailing address

645 E MISSOURI AVE STE 300
PHOENIX AZ
85012-1351
US

V. Phone/Fax

Practice location:
  • Phone: 623-327-4000
  • Fax:
Mailing address:
  • Phone: 602-262-8917
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN192858
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number248026
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: