Healthcare Provider Details

I. General information

NPI: 1679687396
Provider Name (Legal Business Name): SHAWN F KINROSS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 N MAIN ST
CEDAR CITY UT
84720-9746
US

IV. Provider business mailing address

325 S STACI CT
CEDAR CITY UT
84720-1828
US

V. Phone/Fax

Practice location:
  • Phone: 801-993-9501
  • Fax: 801-733-5872
Mailing address:
  • Phone: 435-586-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number309521-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: