Basic Information
| Provider Information | |||||||||
| NPI: | 1750725594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EARL | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | RN, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3939 SAMUELSON WAY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958342047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015103985 | ||||||||
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| Practice Location | |||||||||
| Address1: | 726 4TH ST | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959015656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307407928 | ||||||||
| FaxNumber: | 5307514906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2013 | ||||||||
| LastUpdateDate: | 04/17/2017 | ||||||||
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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 | 163W00000X | 212667 | SC | N | Nursing Service Providers | Registered Nurse | 367500000X | APRN86144 | WV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 95000680 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.