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General NPI Number Information
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NPI Number | 1508280256
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Entity Type | Individual
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Provider Name | RYAN UPTMOR CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/14/2014
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 4815 ALAMEDA AVE
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City | EL PASO
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State | TX
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Zip | 79905-2705
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Country | US
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Telephone | 509-552-9247
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1
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City | ASOTIN
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State | WA
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Zip | 99402-0001
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Country | US
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Telephone | 509-552-9247
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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 | N-38443
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License Number State | ID
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