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General NPI Number Information
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NPI Number | 1194347252
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Entity Type | Organization
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Legal Business Name | ELEVATE ANESTHESIA LLC
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 1524 W 5TH ST
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City | SHERIDAN
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State | WY
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Zip | 82801-2707
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Country | US
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Telephone | 307-672-7874
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3514
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City | IDAHO FALLS
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State | ID
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Zip | 83403-3514
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Country | US
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Telephone | 208-525-2090
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Fax | 208-523-8978
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Authorized Official
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Title or Position | OWNER
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Name | AMBER DAWN KNUTHS
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Credential | CRNA
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Telephone | 406-647-9622
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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 |
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License Number State |
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