Healthcare Provider Details

I. General information

NPI: 1023680519
Provider Name (Legal Business Name): BENJAMIN COREY GERUN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BEN GERUN CRNA

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N TRIUMPH BLVD
LEHI UT
84043-4999
US

IV. Provider business mailing address

715 CHERRY HILL DR
PLEASANT GROVE UT
84062-2935
US

V. Phone/Fax

Practice location:
  • Phone: 385-345-3000
  • Fax:
Mailing address:
  • Phone: 801-400-8626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7810
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8281608-4406
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA243051
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC-APN.0004101-C-CRNA
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: