Healthcare Provider Details

I. General information

NPI: 1699751040
Provider Name (Legal Business Name): MARK EDWARD OSWALD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 E ROXBURY PL
AURORA CO
80016-4149
US

IV. Provider business mailing address

24900 E ROXBURY PL
AURORA CO
80016-4149
US

V. Phone/Fax

Practice location:
  • Phone: 303-690-1550
  • Fax: 303-690-0987
Mailing address:
  • Phone: 303-690-1550
  • Fax: 303-690-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number84034
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: