Provider Demographics
NPI:1144843004
Name:NEVONEN, GREGORY (CRNA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:NEVONEN
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 1:7848 ALCAMO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2504
Mailing Address - Country:US
Mailing Address - Phone:760-567-7991
Mailing Address - Fax:
Practice Address - Street 1:3455 SENN RD BLDG 74
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5030
Practice Address - Country:US
Practice Address - Phone:760-567-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA778295367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered