Healthcare Provider Details

I. General information

NPI: 1144429994
Provider Name (Legal Business Name): BRENNA ELENA WOLFORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENNA ELENA LOPEZ-OTERO CRNA

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61069 SE ECHO LAKE CT.
BEND OR
97702
US

IV. Provider business mailing address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5499
US

V. Phone/Fax

Practice location:
  • Phone: 541-490-3527
  • Fax:
Mailing address:
  • Phone: 480-301-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number39
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2976
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200560029CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: