Individual
ADAM RUSSELL PENROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-2000
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0001251248
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
66709
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123851
NBCRNA - BOARD CERTIFICATION
VA
Enumeration date
01/16/2019
Last updated
11/08/2024
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