Healthcare Provider Details

I. General information

NPI: 1477874709
Provider Name (Legal Business Name): CHRISTAN FORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 23RD ST
FREMONT NE
68025-2303
US

IV. Provider business mailing address

825 S 169TH ST FL 3
OMAHA NE
68118-9300
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-3396
  • Fax: 402-727-3749
Mailing address:
  • Phone: 402-354-4822
  • Fax: 402-354-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number124602
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101132
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: