Healthcare Provider Details

I. General information

NPI: 1750505780
Provider Name (Legal Business Name): SCOTT WHITAKER CRNA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 W 4050 N
PLEASANT VIEW UT
84414-1182
US

IV. Provider business mailing address

268 W 4050 N
PLEASANT VIEW UT
84414-1182
US

V. Phone/Fax

Practice location:
  • Phone: 801-643-3506
  • Fax:
Mailing address:
  • Phone: 801-643-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberN30696
License Number StateID

VIII. Authorized Official

Name: SCOTT WHITAKER
Title or Position: OWNER
Credential: CRNA
Phone: 801-643-3506