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General NPI Number Information
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NPI Number | 1851120125
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Entity Type | Individual
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Provider Name | CONNOR LIVINGSTON CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/26/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 4605 E ELWOOD ST STE 500
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City | PHOENIX
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State | AZ
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Zip | 85040-1978
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Country | US
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Telephone | 602-200-9021
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 LAKESIDE BLVD STE 600
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City | RICHARDSON
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State | TX
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Zip | 75082-4416
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Country | US
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Telephone | 435-313-2738
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 11291775-3102
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License Number State | UT
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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 | 312089
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License Number State | AZ
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