Provider Demographics
NPI:1477658375
Name:VAN ATTA, LAWRENCE C (CRNA)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:C
Last Name:VAN ATTA
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 981357
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-1357
Mailing Address - Country:US
Mailing Address - Phone:435-615-1514
Mailing Address - Fax:
Practice Address - Street 1:300 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4218
Practice Address - Country:US
Practice Address - Phone:800-748-4868
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT215357-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107026171101OtherIHC
UT2000575OtherUNITED HEALTH
UTQM0000076612OtherALTIUS
UT8567OtherHEALTHY U
UT809498OtherDESERET MUTUAL
UT270041325LV2OtherEDUCATORS MUTUAL
UT74393OtherPEHP
UTP92586Medicare UPIN
UT8567OtherHEALTHY U