Healthcare Provider Details

I. General information

NPI: 1346483666
Provider Name (Legal Business Name): CHAD AARON BAGLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 AVENUE B
SCOTTSBLUFF NE
69361-4602
US

IV. Provider business mailing address

541 W 40TH ST
SCOTTSBLUFF NE
69361-0608
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-3711
  • Fax:
Mailing address:
  • Phone: 801-891-4608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101080
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: