Healthcare Provider Details

I. General information

NPI: 1235157900
Provider Name (Legal Business Name): KEVIN L O'LENA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8144 E CACTUS RD SUITE 800
SCOTTSDALE AZ
85260-5266
US

IV. Provider business mailing address

3432 E GEORGIA AVE
PHOENIX AZ
85018-1501
US

V. Phone/Fax

Practice location:
  • Phone: 480-596-8525
  • Fax: 480-596-8522
Mailing address:
  • Phone: 602-505-1558
  • Fax: 602-956-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3-003213
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0407
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number073679
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: