=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205206190
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITNEY ANN CARLSON CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2015
-----------------------------------------------------
Last Update Date | 10/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 N. HIGLEY
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-543-2600
-----------------------------------------------------
Fax | 480-981-2407
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4292 E MESQUITE ST
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85296-1195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-681-5738
-----------------------------------------------------
Fax | 480-699-1950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | CRNA1172
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------