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NPI Code Detail

MEDICARE: RICHARD D SEPELA CRNA

MEDICARE: RICHARD D SEPELA CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistRN332922LPA
2367500000XCertified Registered Nurse AnesthetistCRNA1206AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467456335
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD D SEPELA CRNA
Provider Business Mailing Address
First Line : 1200 N BEAVER ST
Second Line : PAYER CREDENTIALING
City : FLAGSTAFF
State : AZ
Zip : 86001-3118
Country : US
Telephone Number : 928-213-6235
Fax Number : 928-213-6292
Provider Business Practice Location Address
First Line : 269 S CANDY LN
Second Line :
City : COTTONWOOD
State : AZ
Zip : 86326-4158
Country : US
Telephone Number : 928-639-6150
Fax Number : 928-639-6561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 01/15/2021

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