Healthcare Provider Details

I. General information

NPI: 1003167925
Provider Name (Legal Business Name): CRAIG WHITE CRNA, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 W COUNTY LINE RD
WILLCOX AZ
85643-3739
US

IV. Provider business mailing address

8701 W COUNTY LINE RD
WILLCOX AZ
85643-3739
US

V. Phone/Fax

Practice location:
  • Phone: 662-801-8866
  • Fax:
Mailing address:
  • Phone: 662-801-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNUR-APRN-LIC-233727
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN155905
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: