Healthcare Provider Details

I. General information

NPI: 1053522896
Provider Name (Legal Business Name): CRAIG E PARKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MEDICAL DR SURGERY DEPARTMENT
SALT LAKE CITY UT
84132-1000
US

IV. Provider business mailing address

2666 OAKWOOD DR
BOUNTIFUL UT
84010-3241
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-3195
  • Fax:
Mailing address:
  • Phone: 801-294-7953
  • Fax: 801-294-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number190914-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: