Healthcare Provider Details

I. General information

NPI: 1194785790
Provider Name (Legal Business Name): RONALD W TROY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S WHITE ST N/A
MOUNT PLEASANT IA
52641-2262
US

IV. Provider business mailing address

407 S WHITE ST N/A
MOUNT PLEASANT IA
52641-2262
US

V. Phone/Fax

Practice location:
  • Phone: 319-385-3141
  • Fax: 319-385-6571
Mailing address:
  • Phone: 319-385-3141
  • Fax: 319-385-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number39893
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: