Healthcare Provider Details

I. General information

NPI: 1568143469
Provider Name (Legal Business Name): ASPEN ANESTHESIA SERVICES PAIN EXPERTS AND NURSING NETWORKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 WILBUR CT
HEMET CA
92544-1892
US

IV. Provider business mailing address

4270 WILBUR CT
HEMET CA
92544-1892
US

V. Phone/Fax

Practice location:
  • Phone: 870-897-1774
  • Fax:
Mailing address:
  • Phone: 870-897-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KELLY KAIULANI NORRIS
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CRNA
Phone: 951-282-0036