1952628505 NPI number — MR. WESTON MARSHALL SWINDLEHURST CRNA

Table of content: MR. WESTON MARSHALL SWINDLEHURST CRNA (NPI 1952628505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952628505 NPI number — MR. WESTON MARSHALL SWINDLEHURST CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWINDLEHURST
Provider First Name:
WESTON
Provider Middle Name:
MARSHALL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952628505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 KINGFISHER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82930-6702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-590-7817
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 NORTH MAIN ST
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
KANAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-644-5811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  30225.1154 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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