Healthcare Provider Details

I. General information

NPI: 1932198769
Provider Name (Legal Business Name): CALVIN PARKER KREMIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
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

682 W 650 S
LAYTON UT
84041-3855
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-2350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100771
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number214111-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: