Provider Demographics
NPI:1932446093
Name:BUCHHOLZ, TRICIA (CRNA)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W MOHAVE RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-6349
Mailing Address - Country:US
Mailing Address - Phone:928-669-9201
Mailing Address - Fax:
Practice Address - Street 1:1200 W MOHAVE RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-6349
Practice Address - Country:US
Practice Address - Phone:928-669-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0929367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered