Healthcare Provider Details

I. General information

NPI: 1912176819
Provider Name (Legal Business Name): ERIC SEAN WHITE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 W 16TH AVE
DENVER CO
80204-1335
US

IV. Provider business mailing address

2646 PERRY ST
DENVER CO
80212-1270
US

V. Phone/Fax

Practice location:
  • Phone: 719-537-0712
  • Fax: 719-537-6284
Mailing address:
  • Phone: 303-912-6186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5570
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: