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General NPI Number Information
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NPI Number | 1841243474
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Entity Type | Individual
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Provider Name | WALTER JESSE TRUDO CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 09/04/2026
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Provider Practice Location Address
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Address Line | 3733 N. BUSINESS DR. SUITE 101
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-443-5476
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Fax |
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Provider Business Mailing Address
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Address Line | 1803 SW HAYFIELD AVENUE
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City | BENTONVILLE
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State | AR
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Zip | 72713
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Country | US
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Telephone | 479-659-2746
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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 0090514
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License Number State | OK
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