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General NPI Number Information
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NPI Number | 1649292897
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Entity Type | Individual
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Provider Name | SHAUN EVANS CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 1000 E 100 N
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City | PAYSON
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State | UT
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Zip | 84651-1600
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Country | US
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Telephone | 800-748-4868
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Fax | 801-733-5872
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Provider Business Mailing Address
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Address Line | 926 ARROWHEAD TRAIL RD
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City | SPANISH FORK
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State | UT
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Zip | 84660-9240
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Country | US
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Telephone | 801-794-9937
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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 | 201863-4406
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License Number State | UT
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