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General NPI Number Information
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NPI Number | 1356886832
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Entity Type | Individual
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Provider Name | JEREMY HENRIE CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 6200 N LA CHOLLA BLVD
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City | TUCSON
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State | AZ
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Zip | 85741-3529
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Country | US
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Telephone | 520-742-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 10660 S REMBRANDT LN
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City | SANDY
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State | UT
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Zip | 84070-5224
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Country | US
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Telephone | 804-594-2622
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Fax | 804-594-0915
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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 | 8380193-3102
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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 | 329019
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License Number State | AZ
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