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General NPI Number Information
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NPI Number | 1497146054
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Entity Type | Individual
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Provider Name | ALEXANDER JOHN FERDA CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 10/10/2025
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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 | 929 HURON AVE
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City | PORT HURON
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State | MI
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Zip | 48060-3706
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Country | US
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Telephone | 810-987-7304
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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 | 4704276743
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License Number State | MI
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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 | 330630
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704276743
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License Number State | MI
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