Healthcare Provider Details

I. General information

NPI: 1780625814
Provider Name (Legal Business Name): ANTHONY T YOUNG CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/27/2023
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 6TH AVE SW
RONAN MT
59864-2634
US

IV. Provider business mailing address

116 ORCHARD PARK LN
POLSON MT
59860-7222
US

V. Phone/Fax

Practice location:
  • Phone: 406-676-4441
  • Fax:
Mailing address:
  • Phone: 406-249-9394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number36786
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: