Healthcare Provider Details

I. General information

NPI: 1447819586
Provider Name (Legal Business Name): CRAIG D WHITE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 11/24/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 3RD ST S
GLASGOW MT
59230-2604
US

IV. Provider business mailing address

621 3RD ST S
GLASGOW MT
59230-2604
US

V. Phone/Fax

Practice location:
  • Phone: 406-228-3645
  • Fax: 406-228-3533
Mailing address:
  • Phone: 406-228-3645
  • Fax: 406-228-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number93627
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR47884
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number146714
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: