Healthcare Provider Details

I. General information

NPI: 1225048937
Provider Name (Legal Business Name): LAYNE B CROXFORD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4364 WASHINGTON BLVD
OGDEN UT
84403-1866
US

IV. Provider business mailing address

PO BOX 210
ROY UT
84067-0210
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-4470
  • Fax:
Mailing address:
  • Phone: 801-825-4700
  • Fax: 801-825-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2044784406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: