Healthcare Provider Details

I. General information

NPI: 1427050186
Provider Name (Legal Business Name): NANCY LYNN KNAPE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 WASHINGTON BLVD STE 105
OGDEN UT
84401-4149
US

IV. Provider business mailing address

PO BOX 837
OGDEN UT
84402-0837
US

V. Phone/Fax

Practice location:
  • Phone: 801-392-0402
  • Fax: 801-393-3334
Mailing address:
  • Phone: 801-392-0402
  • Fax: 801-393-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number347854-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: