Healthcare Provider Details

I. General information

NPI: 1639276942
Provider Name (Legal Business Name): JOHN O HARMON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E FOREMASTER DR
ST GEORGE UT
84790
US

IV. Provider business mailing address

2130 E WYOMING DR
SAINT GEORGE UT
84770-2204
US

V. Phone/Fax

Practice location:
  • Phone: 702-489-5460
  • Fax:
Mailing address:
  • Phone: 801-787-2827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number262390-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: