Healthcare Provider Details

I. General information

NPI: 1639480577
Provider Name (Legal Business Name): JARED CRAIG WEEKES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 E BASELINE RD SUITE 102
TEMPE AZ
85283-1533
US

IV. Provider business mailing address

5281 N 99TH AVE SUITE 100
GLENDALE AZ
85305-3105
US

V. Phone/Fax

Practice location:
  • Phone: 623-516-8252
  • Fax: 623-516-8253
Mailing address:
  • Phone: 623-516-8252
  • Fax: 623-512-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN614926
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1145
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: