Provider Demographics
NPI:1144319849
Name:THYGERSON, MICHAEL R (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:THYGERSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85502-0386
Mailing Address - Country:US
Mailing Address - Phone:928-961-3902
Mailing Address - Fax:
Practice Address - Street 1:5880 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9447
Practice Address - Country:US
Practice Address - Phone:928-961-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT286558-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT70681OtherPEHP
UTTPRA08440OtherMOLINA
UT107013149101OtherIHC
UT190683600OtherUS DEPT OF LABOR
UT28655844000001OtherBCBS
UT870666269THYOtherEDUCATORS MUTUAL
UT780194OtherDESERET MUTUAL
UT18330OtherHEALTHY U
UTQM0000054865OtherALTIUS
UTQM0000054865OtherALTIUS
UT70681OtherPEHP
UT870666269THYOtherEDUCATORS MUTUAL