Individual provider · NPI-1

Jacob Buckway, CRNA

Nurse Anesthetist, Certified Registered · Ogden, UT

NPI number1346908464
StatusActive
Last updated in NPPESDec 6, 2021

Details

NPI
1346908464
Entity type
Individual (NPI-1)
Name
Jacob Buckway
Credential
CRNA
Sex
Male
Sole proprietor
No
Enumeration date
Dec 6, 2021
Certification date
Dec 6, 2021
Last updated
Dec 6, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
367500000X Nurse Anesthetist, Certified Registered94443013102UTYes

Practice location

5475 S 500 E
Ogden, UT 84405-6905

Phone 801-479-2111

Mailing address

1059 N 175 E
Layton, UT 84041-2477

Phone 801-719-0045

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