Individual
THOMAS J. TAVENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1000 N MAIN ST, RICHFIELD, UT 84701-1857
(435) 893-4100
Mailing address
1105 N 500 E, RICHFIELD, UT 84701-1917
(435) 896-2934
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
149511205797
UT
Other
Enumeration date
09/14/2006
Last updated
02/26/2009
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