Provider Demographics
NPI:1750889804
Name:NOBLE DREAMS ANESTHESIA LLC
Entity type:Organization
Organization Name:NOBLE DREAMS ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER/CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:865-384-6465
Mailing Address - Street 1:14713 SE PAGE PARK CT
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4258
Mailing Address - Country:US
Mailing Address - Phone:865-384-6465
Mailing Address - Fax:
Practice Address - Street 1:3099 RIVER RD S # 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-9754
Practice Address - Country:US
Practice Address - Phone:503-758-0892
Practice Address - Fax:503-966-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201392028CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty