Provider Demographics
NPI:1235157900
Name:O'LENA, KEVIN L (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:O'LENA
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 1:3432 E GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1501
Mailing Address - Country:US
Mailing Address - Phone:602-505-1558
Mailing Address - Fax:602-956-0860
Practice Address - Street 1:8144 E CACTUS RD
Practice Address - Street 2:SUITE 800
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5266
Practice Address - Country:US
Practice Address - Phone:480-596-8525
Practice Address - Fax:480-596-8522
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ073679163W00000X
AZCRNA0407367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAX0494OtherHEALTHNET
AZ0424370OtherBLUE CROSS BLUE SHIELD
AZ998601Medicaid
P00313023OtherRAILROAD MEDICARE
AZAX0494OtherHEALTHNET