Provider Demographics
NPI:1679916670
Name:HARTLEY, TODD JAMES (CRNA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:JAMES
Last Name:HARTLEY
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 1:1638 S 500 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-8600
Mailing Address - Country:US
Mailing Address - Phone:801-372-4523
Mailing Address - Fax:
Practice Address - Street 1:1638 S 500 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-8600
Practice Address - Country:US
Practice Address - Phone:801-372-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0932367500000X
UT5369390-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered