MEDICARE: SCOTT WHITAKER CRNA PC

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
1	367500000X	Certified Registered Nurse Anesthetist	N30696	ID

Other Identifiers

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

General Provider Information

NPI Number	:	1750505780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT WHITAKER CRNA PC

Provider Business Mailing Address
First Line	:	268 W 4050 N
Second Line	:
City	:	PLEASANT VIEW
State	:	UT
Zip	:	84414-1182
Country	:	US
Telephone Number	:	801-643-3506
Fax Number	:

Provider Business Practice Location Address
First Line	:	268 W 4050 N
Second Line	:
City	:	PLEASANT VIEW
State	:	UT
Zip	:	84414-1182
Country	:	US
Telephone Number	:	801-643-3506
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT WHITAKER
Credential	:	CRNA
Telephone Number	:	801-643-3506

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	11/12/2010

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