Healthcare Provider Details

I. General information

NPI: 1881083632
Provider Name (Legal Business Name): SUZANNE MASIAS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 KALAMATH ST
DENVER CO
80204-2527
US

IV. Provider business mailing address

17 SADDLE RIDGE DR
FORT MORGAN CO
80701-4202
US

V. Phone/Fax

Practice location:
  • Phone: 303-325-4844
  • Fax:
Mailing address:
  • Phone: 303-325-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0991610-CRNA
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number131248
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3015444
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number557330
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101830
License Number StateNE
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number113481
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: