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General NPI Number Information
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NPI Number | 1063961928
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Entity Type | Individual
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Provider Name | CHASE BAZIL CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/03/2016
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 1900 N STATE ST STE 105
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City | PROVO
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State | UT
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Zip | 84604-1354
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Country | US
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Telephone | 801-655-5245
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Fax |
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Provider Business Mailing Address
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Address Line | 348 W 90 S
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City | SALEM
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State | UT
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Zip | 84653-9158
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Country | US
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Telephone | 208-351-0283
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 9902165-4406
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 9902165-8901
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License Number State | UT
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