Healthcare Provider Details

I. General information

NPI: 1699790113
Provider Name (Legal Business Name): MICHAEL A DAGLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 S HIGHWAY 40
HEBER CITY UT
84032-3522
US

IV. Provider business mailing address

1089 E 270 N
HEBER CITY UT
84032-3051
US

V. Phone/Fax

Practice location:
  • Phone: 435-654-2500
  • Fax:
Mailing address:
  • Phone: 435-654-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number049473
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: