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General NPI Number Information
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NPI Number | 1972825370
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Entity Type | Organization
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Legal Business Name | CBT ANESTHESIA, PC
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 4364 WASHINGTON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-1866
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Country | US
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Telephone | 801-781-4012
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Fax |
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Provider Business Mailing Address
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Address Line | 4364 WASHINGTON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-1866
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Country | US
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Telephone | 801-781-4012
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CAROL B TANNER
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Credential | CRNA
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Telephone | 801-726-1340
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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 | 2043774406
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License Number State | UT
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