Individual
EVAN B THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1000 E 100 N, PAYSON, UT 84651-1600
(800) 748-4868
(801) 733-5872
Mailing address
32 W 1320 S, PAYSON, UT 84651-3012
(801) 465-3844
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
375417-4406
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34456
HEALTHY U
UT
01
—
894814
DESERET MUTUAL
UT
Enumeration date
09/12/2006
Last updated
07/08/2007
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