Provider Demographics
NPI:1447400742
Name:IMUS, FREDERICK SCOTT (CRNA)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:SCOTT
Last Name:IMUS
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:17505 N 79TH AVE STE 304A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8729
Mailing Address - Country:US
Mailing Address - Phone:480-407-6400
Mailing Address - Fax:480-407-6520
Practice Address - Street 1:9023 E DESERT COVE AVE STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6779
Practice Address - Country:US
Practice Address - Phone:480-407-6400
Practice Address - Fax:480-407-6520
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZCRNA0698367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered