Individual
MATHIAS DARRELL RUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
77 W FOREST AVE STE 117, FLAGSTAFF, AZ 86001-1482
(928) 773-2505
(928) 773-2504
Mailing address
77 W FOREST AVE STE 117, FLAGSTAFF, AZ 86001-1482
(928) 773-2505
(928) 773-2504
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
256689
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA1070
AZ
Other
Enumeration date
08/29/2014
Last updated
09/24/2018
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