Provider Demographics
NPI:1063961928
Name:BAZIL, CHASE (CRNA)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:BAZIL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 W 90 S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-9158
Mailing Address - Country:US
Mailing Address - Phone:208-351-0283
Mailing Address - Fax:
Practice Address - Street 1:1900 N STATE ST STE 105
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1354
Practice Address - Country:US
Practice Address - Phone:801-655-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9902165-4406367500000X
UT9902165-8901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered