Healthcare Provider Details

I. General information

NPI: 1124427083
Provider Name (Legal Business Name): ELOSIA FURBEE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2014
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N MAIN ST
RICHFIELD UT
84701-2061
US

IV. Provider business mailing address

2080 E SR 119
RICHFIELD UT
84701-9414
US

V. Phone/Fax

Practice location:
  • Phone: 435-893-4100
  • Fax:
Mailing address:
  • Phone: 402-880-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number10804042-4406
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number68571
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: