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General NPI Number Information
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NPI Number | 1952442675
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Entity Type | Individual
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Provider Name | ROBERT D NORTHERN JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 243 GREEN VALLEY RD STE F
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City | FREEDOM
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State | CA
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Zip | 95019-3133
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Country | US
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Telephone | 831-763-0407
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Fax |
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Provider Business Mailing Address
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Address Line | 416B MAIN ST
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City | SALINAS
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State | CA
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Zip | 93901-3306
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Country | US
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Telephone | 831-800-7887
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Fax | 831-998-7155
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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 | 200560036CRNA
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License Number State | OR
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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 | NA1788
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License Number State | CA
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