Healthcare Provider Details

I. General information

NPI: 1043450554
Provider Name (Legal Business Name): EMILY CHIPPING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 W PLEASANT GROVE BLVD
PLEASANT GROVE UT
84062
US

IV. Provider business mailing address

3551 EASTOAKS DR
SALT LAKE CITY UT
84124-3810
US

V. Phone/Fax

Practice location:
  • Phone: 801-785-5100
  • Fax:
Mailing address:
  • Phone: 714-795-8976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704288956
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3821
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5989580-8901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: