Healthcare Provider Details

I. General information

NPI: 1750725594
Provider Name (Legal Business Name): SCOTT THOMAS EARL RN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E THOMAS RD
PHOENIX AZ
85016-7711
US

IV. Provider business mailing address

816 LYMINGTON RD
EL PASO TX
79928-7743
US

V. Phone/Fax

Practice location:
  • Phone: 602-532-1000
  • Fax:
Mailing address:
  • Phone: 801-510-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number866601
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number268343
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: