Provider Demographics
NPI:1780086843
Name:LITTLE VALLEY ANESTHESIA LLC
Entity type:Organization
Organization Name:LITTLE VALLEY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMETT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:435-225-5836
Mailing Address - Street 1:89 E FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:UT
Mailing Address - Zip Code:84324-4379
Mailing Address - Country:US
Mailing Address - Phone:435-225-5836
Mailing Address - Fax:
Practice Address - Street 1:89 E FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:UT
Practice Address - Zip Code:84324-4379
Practice Address - Country:US
Practice Address - Phone:435-225-5836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-20
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT216299-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty