Provider Demographics
NPI:1508886193
Name:AST, EDITH ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:ANN
Last Name:AST
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:20203 N CROWN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-3714
Mailing Address - Country:US
Mailing Address - Phone:623-687-1717
Mailing Address - Fax:623-584-9968
Practice Address - Street 1:20203 N CROWN RIDGE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-3714
Practice Address - Country:US
Practice Address - Phone:623-687-1717
Practice Address - Fax:623-584-9968
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZCRNA0339367500000X
AZRN132685163W00000X
TXCOMPACT LICENSE367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX693070OtherSTATE