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General NPI Number Information
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NPI Number | 1457466963
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Entity Type | Individual
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Provider Name | SAMUEL JOHN MITZEL CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 3333 S WADSWORTH BLVD UNIT D100
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City | LAKEWOOD
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State | CO
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Zip | 80227-5117
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Country | US
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Telephone | 303-205-1090
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Fax | 303-205-5534
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Provider Business Mailing Address
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Address Line | 2907 70TH AVE
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City | GREELEY
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State | CO
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Zip | 80634-8969
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Country | US
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Telephone |
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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 | R 168226 5
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License Number State | MN
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