Healthcare Provider Details

I. General information

NPI: 1740742667
Provider Name (Legal Business Name): JONATHAN HYATT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

PO BOX 3570
SALT LAKE CITY UT
84110-3570
US

V. Phone/Fax

Practice location:
  • Phone: 801-727-2056
  • Fax: 770-701-6675
Mailing address:
  • Phone: 801-727-2056
  • Fax: 770-701-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number819572
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6179728-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: