Healthcare Provider Details

I. General information

NPI: 1932030996
Provider Name (Legal Business Name): TAYLOR ELIJAH ALBRECHT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N MAIN ST
TOOELE UT
84074-9819
US

IV. Provider business mailing address

716 COUNTRY CLUB DR
STANSBURY PARK UT
84074-9624
US

V. Phone/Fax

Practice location:
  • Phone: 435-843-3600
  • Fax:
Mailing address:
  • Phone: 801-550-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11289967-8901
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11289967-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: