Healthcare Provider Details

I. General information

NPI: 1598208795
Provider Name (Legal Business Name): RYAN STEED CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4248 E TAHITI ST
MERIDIAN ID
83646-6341
US

IV. Provider business mailing address

4248 E TAHITI ST
MERIDIAN ID
83646-6341
US

V. Phone/Fax

Practice location:
  • Phone: 801-404-4234
  • Fax:
Mailing address:
  • Phone: 801-404-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number53936
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: