Basic Information
| Provider Information | |||||||||
| NPI: | 1336576560 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CODDINGTON | ||||||||
| FirstName: | MATHEW | ||||||||
| MiddleName: | RAY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 126 WHITE SAGE AVE | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846248937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4358645591 | ||||||||
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| Practice Location | |||||||||
| Address1: | 126 WHITE SAGE AVE | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4358645591 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2013 | ||||||||
| LastUpdateDate: | 06/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 101292 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.