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WAYNE REX RIDING

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
96 E KIMBALLS LN STE 100, DRAPER, UT 84020-5021
(801) 319-5095
Mailing address
1301 S 550 W, SALEM, UT 84653-9173
(801) 319-5095

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0294124-4406
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
107004477101
IHC
UT
01
190382600
US DEPT OF LABOR
UT
01
56221
HEALTHY U
UT
01
870525882RID
EDUCATORS MUTUAL
UT
01
PRA04893
MOLINA
UT
01
QM0000076595
ALTIUS
UT
Enumeration date
09/13/2006
Last updated
11/06/2024
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