Healthcare Provider Details

I. General information

NPI: 1336256668
Provider Name (Legal Business Name): LEWIS LAMAR BARNEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 400 E
PANGUITCH UT
84759-0389
US

IV. Provider business mailing address

200 N 400 E
PANGUITCH UT
84759-0389
US

V. Phone/Fax

Practice location:
  • Phone: 435-676-8811
  • Fax: 435-676-2679
Mailing address:
  • Phone: 435-676-8811
  • Fax: 435-676-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number3268734406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: