Healthcare Provider Details

I. General information

NPI: 1033536388
Provider Name (Legal Business Name): CHERIE CARPENTER BATE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 100 N
PAYSON UT
84651-1600
US

IV. Provider business mailing address

7836 PINEBROOK RD
PARK CITY UT
84098-4606
US

V. Phone/Fax

Practice location:
  • Phone: 801-857-8841
  • Fax:
Mailing address:
  • Phone: 801-857-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1957474406
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1957478901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: