Basic Information
| Provider Information | |||||||||
| NPI: | 1538766993 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYNTON | ||||||||
| FirstName: | RYAN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3863 E DIAMOND AVE | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808610995 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7301 N 16TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850205266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804204027 | ||||||||
| FaxNumber: | 6025350940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2020 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN190324 | AZ | N | Nursing Service Providers | Registered Nurse | 207L00000X | 248805 | AZ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | 248805 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.