Provider Demographics
NPI:1164528832
Name:CRAGUN, MICHAEL D (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:CRAGUN
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 1:905 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-9356
Mailing Address - Country:US
Mailing Address - Phone:435-452-2238
Mailing Address - Fax:
Practice Address - Street 1:905 N 1000 W
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-9356
Practice Address - Country:US
Practice Address - Phone:435-452-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT284836-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107027335101OtherIHC
UT28483644000001OtherBCBS
UTTPRA10379OtherMOLINA
UT77633OtherPEHP
UT55469OtherHEALTHY U
UT838734OtherDESERET MUTUAL
UT870666269MCROtherEDUCATORS MUTUAL
UTQM0000054865OtherALTIUS
UTP27062Medicare UPIN
UT77633OtherPEHP