Healthcare Provider Details

I. General information

NPI: 1164528832
Provider Name (Legal Business Name): MICHAEL D CRAGUN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N 1000 W
TREMONTON UT
84337-9356
US

IV. Provider business mailing address

905 N 1000 W
TREMONTON UT
84337-9356
US

V. Phone/Fax

Practice location:
  • Phone: 435-452-2238
  • Fax:
Mailing address:
  • Phone: 435-452-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number284836-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: