Healthcare Provider Details

I. General information

NPI: 1336268655
Provider Name (Legal Business Name): PAULINE FROME CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 E 5000 S
VERNAL UT
84078-9344
US

IV. Provider business mailing address

3021 E 5000 S
VERNAL UT
84078-9344
US

V. Phone/Fax

Practice location:
  • Phone: 435-790-1877
  • Fax:
Mailing address:
  • Phone: 435-790-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number204175-8901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: