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Organization

FOUNTAIN ANESTHESIA, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ANGELA FOUNTAIN CRNA (CEO)
(480) 414-1295
Entity
Organization

Contact information

Practice address
5000 E PALOMINO LN UNIT 21, FLAGSTAFF, AZ 86004-7444
(480) 414-1295
Mailing address
5000 E PALOMINO LN UNIT 21, FLAGSTAFF, AZ 86004-7444
(480) 414-1295

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary

Other

Enumeration date
09/02/2022
Last updated
12/06/2022
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