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NPI Code Detail

MEDICARE: MR. DARIN WESLEY BLOOMFIELD CRNA, MHS

MEDICARE: MR. DARIN WESLEY BLOOMFIELD CRNA, MHS
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 Anesthetist6800670-4406UT
2163W00000XRegistered Nurse6800670-3102UT

General Provider Information

NPI Number : 1760750368
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DARIN WESLEY BLOOMFIELD CRNA, MHS
Provider Business Mailing Address
First Line : 755 BIRCH DR
Second Line :
City : DELTA
State : UT
Zip : 84624-8944
Country : US
Telephone Number : 801-391-3810
Fax Number :
Provider Business Practice Location Address
First Line : 126 WHITE SAGE AVE
Second Line :
City : DELTA
State : UT
Zip : 84624-8937
Country : US
Telephone Number : 435-864-5591
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2011
Last Update Date : 01/24/2012

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