Individual
MR. PAUL WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
75 COLONIA DE SALUD STE 200C, SIERRA VISTA, AZ 85635-2486
(520) 226-4338
Mailing address
77 CALLE PORTAL STE B260A, SIERRA VISTA, AZ 85635-2998
(520) 226-4338
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN60090792
WA
367500000X
Certified Registered Nurse Anesthetist
AP60037040
WA
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
884282
—
AZ
05
—
9662008
—
WA
Enumeration date
04/11/2006
Last updated
11/28/2016
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