Healthcare Provider Details

I. General information

NPI: 1457339848
Provider Name (Legal Business Name): RENEE ANDERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 16TH ST
GREELEY CO
80631
US

IV. Provider business mailing address

1801 16TH ST
GREELEY CO
80631-5154
US

V. Phone/Fax

Practice location:
  • Phone: 970-350-6399
  • Fax: 970-378-4687
Mailing address:
  • Phone: 970-350-6399
  • Fax: 970-378-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRA-644
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR46512
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0000644-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: