Provider Demographics
NPI:1528309697
Name:KRAGER, JODY M (CRNA)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:M
Last Name:KRAGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:891 E PEACH TREE PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5609
Mailing Address - Country:US
Mailing Address - Phone:480-899-9800
Mailing Address - Fax:480-899-2994
Practice Address - Street 1:875 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5710
Practice Address - Country:US
Practice Address - Phone:480-899-9800
Practice Address - Fax:480-899-2994
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMNCRNA2140367500000X
AZCRNA0919367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ163657Medicare PIN