MEDICARE: WAYNE REX RIDING 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
1	367500000X	Certified Registered Nurse Anesthetist	0294124-4406	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PRA04893	OTHER	UT	MOLINA
2	56221	OTHER	UT	HEALTHY U
3	QM0000076595	OTHER	UT	ALTIUS
4	107004477101	OTHER	UT	IHC
5	190382600	OTHER	UT	US DEPT OF LABOR
6	870525882RID	OTHER	UT	EDUCATORS MUTUAL

General Provider Information

NPI Number	:	1972608495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE REX RIDING CRNA

Provider Business Mailing Address
First Line	:	1301 S 550 W
Second Line	:
City	:	SALEM
State	:	UT
Zip	:	84653-9173
Country	:	US
Telephone Number	:	801-319-5095
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 E KIMBALLS LN STE 100
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-5021
Country	:	US
Telephone Number	:	801-319-5095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	11/06/2024

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Directions to “ WAYNE REX RIDING CRNA” Practice Location

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