Healthcare Provider Details

I. General information

NPI: 1730557133
Provider Name (Legal Business Name): RYAN SARGENT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 N CENTER ST STE 800
LEHI UT
84043
US

IV. Provider business mailing address

3340 N CENTER ST STE 800
LEHI UT
84043-7406
US

V. Phone/Fax

Practice location:
  • Phone: 801-990-1911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7202773-4406
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1163
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7202773-8901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: