Provider Demographics
NPI:1083785281
Name:CARVER, RICHARD (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:CARVER
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 1477
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-1477
Mailing Address - Country:US
Mailing Address - Phone:307-789-1219
Mailing Address - Fax:307-789-3760
Practice Address - Street 1:195 OVERTHRUST RD.
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9266
Practice Address - Country:US
Practice Address - Phone:307-444-3600
Practice Address - Fax:307-789-3760
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY21113.785367500000X
UT264797-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118226900Medicaid
WYP00023100OtherRAILROAD MEDICARE
WY311872OtherBLUE CROSS BLUE SHIELD
WY118226900Medicaid