Healthcare Provider Details

I. General information

NPI: 1215208848
Provider Name (Legal Business Name): CRYSTAL DESIREE KAFER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL DESIREE RICE

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 NUEVO LEON ST UNIT 4
NORTH LAS VEGAS NV
89031-3699
US

IV. Provider business mailing address

5815 NUEVO LEON ST UNIT 4
NORTH LAS VEGAS NV
89031-3699
US

V. Phone/Fax

Practice location:
  • Phone: 813-476-2396
  • Fax:
Mailing address:
  • Phone: 813-476-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9268631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: