Provider Demographics
NPI:1598790966
Name:HARWARD, ANTHONY C (CRNA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:HARWARD
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 1:3033 N CANYON RD
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3922
Mailing Address - Country:US
Mailing Address - Phone:208-201-3737
Mailing Address - Fax:
Practice Address - Street 1:3033 N CANYON RD
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3922
Practice Address - Country:US
Practice Address - Phone:208-201-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370826-4406367500000X
MTAPRN-104594367500000X
IDRNA-583A367500000X
WAAP60623618367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered