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General NPI Number Information
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NPI Number | 1184138679
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Entity Type | Individual
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Provider Name | BENJAMIN HENRIE CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 1200 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-779-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 167 MAIN ST
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City | TUBA CITY
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State | AZ
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Zip | 86045
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Country | US
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Telephone | 866-976-5941
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Fax | 928-213-6292
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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 | 247924
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License Number State | AZ
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