Provider Demographics
NPI:1306845508
Name:UTTER, FREDERICK S (CRNA)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:S
Last Name:UTTER
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 1:3947 LAS VEGAS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1728
Mailing Address - Country:US
Mailing Address - Phone:915-772-4551
Mailing Address - Fax:915-232-9920
Practice Address - Street 1:1900 DENVER AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3008
Practice Address - Country:US
Practice Address - Phone:915-577-0111
Practice Address - Fax:915-533-2568
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCRNA00801367500000X
TX04035367500000X
TXAP102926367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126119009Medicaid
NM00091755Medicaid
040435OtherCOUNCIL NURSE ANESTHETIST