Healthcare Provider Details

I. General information

NPI: 1538056940
Provider Name (Legal Business Name): SYDNEY ANNE BROWN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W 800 N
OREM UT
84057-3660
US

IV. Provider business mailing address

319 PROFFITT RD
CENTRALIA WA
98531-8920
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-6000
  • Fax:
Mailing address:
  • Phone: 360-388-0829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9511434-8901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: