Healthcare Provider Details

I. General information

NPI: 1730149659
Provider Name (Legal Business Name): JOHN C. RHINEHART CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N MAIN ST
KANAB UT
84741-3260
US

IV. Provider business mailing address

PO BOX 152
KANAB UT
84741-0152
US

V. Phone/Fax

Practice location:
  • Phone: 928-812-2025
  • Fax:
Mailing address:
  • Phone: 928-812-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0369
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: