Healthcare Provider Details

I. General information

NPI: 1356352520
Provider Name (Legal Business Name): RENEE DAWN SALE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 S 500 E
OGDEN UT
84405-6905
US

IV. Provider business mailing address

2050 N 680 W
WEST BOUNTIFUL UT
84087-1119
US

V. Phone/Fax

Practice location:
  • Phone: 800-880-3566
  • Fax: 801-733-5872
Mailing address:
  • Phone: 801-298-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5784240-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: