Provider Demographics
NPI:1801045869
Name:LAYNE B. CROXFORD CRNA PC
Entity Type:Organization
Organization Name:LAYNE B. CROXFORD CRNA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CROXFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:801-726-6332
Mailing Address - Street 1:4364 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1866
Mailing Address - Country:US
Mailing Address - Phone:801-479-4470
Mailing Address - Fax:801-476-7002
Practice Address - Street 1:4364 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1866
Practice Address - Country:US
Practice Address - Phone:801-479-4470
Practice Address - Fax:801-476-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT204478-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000007832Medicare PIN