Provider Demographics
NPI:1902264427
Name:3 2 1 ANESTHESIA LLC
Entity Type:Organization
Organization Name:3 2 1 ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:KP
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:801-391-8432
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84402-0837
Mailing Address - Country:US
Mailing Address - Phone:801-392-0402
Mailing Address - Fax:801-393-3334
Practice Address - Street 1:3480 WASHINGTON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-4149
Practice Address - Country:US
Practice Address - Phone:801-392-0385
Practice Address - Fax:801-393-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT371423-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty