Provider Demographics
NPI:1740503697
Name:RANALLI, LEE JAMES (CRNA)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:JAMES
Last Name:RANALLI
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 1:4838 E BASELINE RD
Mailing Address - Street 2:#108
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4671
Mailing Address - Country:US
Mailing Address - Phone:480-220-4436
Mailing Address - Fax:
Practice Address - Street 1:4838 E BASELINE RD
Practice Address - Street 2:#108
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4671
Practice Address - Country:US
Practice Address - Phone:480-220-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-07
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0708367500000X
AZ146311163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered