Healthcare Provider Details

I. General information

NPI: 1437160645
Provider Name (Legal Business Name): CONNOR ANDERL CRNA
Entity Type: Individual
Gender: Male
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

246 E 1050 N
KAYSVILLE UT
84037-1249
US

V. Phone/Fax

Practice location:
  • Phone: 800-880-3566
  • Fax: 801-733-5872
Mailing address:
  • Phone: 801-476-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number317095-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: