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General NPI Number Information
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NPI Number | 1750198602
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Entity Type | Individual
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Provider Name | GRAYSON FLEMING MCHARGUE CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 101 CIVIC CENTER LN
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5683
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Country | US
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Telephone | 928-855-8185
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Fax |
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Provider Business Mailing Address
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Address Line | 24979 STARR ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2819
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Country | US
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Telephone | 916-882-5959
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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 | 95217169
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License Number State | CA
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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 | 218357
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License Number State | AZ
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