Provider Demographics
NPI:1376686725
Name:WHITAKER, SCOTT D (CRNA,MS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:CRNA,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 W 4050 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1182
Mailing Address - Country:US
Mailing Address - Phone:801-782-1610
Mailing Address - Fax:
Practice Address - Street 1:268 W 4050 N
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-1182
Practice Address - Country:US
Practice Address - Phone:801-782-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2142214406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT513643Medicare UPIN
UT0055763Medicare ID - Type Unspecified