Healthcare Provider Details

I. General information

NPI: 1750529830
Provider Name (Legal Business Name): BARRETT ZANE GARDNER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N 1100 E
AMERICAN FORK UT
84003-2961
US

IV. Provider business mailing address

766 E 400 N
OREM UT
84097-4949
US

V. Phone/Fax

Practice location:
  • Phone: 801-855-3300
  • Fax:
Mailing address:
  • Phone: 860-770-9291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1750529830
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3793
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: