Healthcare Provider Details

I. General information

NPI: 1558797332
Provider Name (Legal Business Name): ALFRED W MAINA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HOSPITAL LOOP
CRAIG CO
81625-8750
US

IV. Provider business mailing address

750 HOSPITAL LOOP
CRAIG CO
81625-8750
US

V. Phone/Fax

Practice location:
  • Phone: 970-826-2400
  • Fax: 970-826-2459
Mailing address:
  • Phone: 970-826-2400
  • Fax: 970-826-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC-APN-0003295-C-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: