Provider Demographics
NPI:1962693895
Name:ROBERT FORD CRNA PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:ROBERT FORD CRNA PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:559-897-2505
Mailing Address - Street 1:1995 BERGREN CT
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2705
Mailing Address - Country:US
Mailing Address - Phone:559-897-2505
Mailing Address - Fax:909-985-3858
Practice Address - Street 1:1141 ROSE AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3241
Practice Address - Country:US
Practice Address - Phone:559-891-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA1271367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty