Healthcare Provider Details

I. General information

NPI: 1376853259
Provider Name (Legal Business Name): JENNIFER KROUT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8422 E SHEA BLVD 103
SCOTTSDALE AZ
85260-6661
US

IV. Provider business mailing address

8422 E SHEA BLVD 103
SCOTTSDALE AZ
85260-6661
US

V. Phone/Fax

Practice location:
  • Phone: 480-478-6620
  • Fax: 480-478-6628
Mailing address:
  • Phone: 480-478-6620
  • Fax: 480-478-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN146412
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberIR949482
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN593562
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: