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General NPI Number Information
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NPI Number | 1962448480
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Entity Type | Individual
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Provider Name | CHANCE GREEN CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 5448 HIGHWAY 260 STE 100
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City | LAKESIDE
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State | AZ
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Zip | 85929-5736
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Country | US
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Telephone | 928-359-1862
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Fax | 928-537-2049
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Provider Business Mailing Address
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Address Line | 135 N CENTER ST UNIT 5870
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City | MESA
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State | AZ
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Zip | 85211-7159
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Country | US
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Telephone | 480-874-7014
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Fax | 480-874-7015
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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 | 28162181
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License Number State | IN
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