Provider Demographics
NPI:1972608495
Name:RIDING, WAYNE REX (CRNA)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:REX
Last Name:RIDING
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 1:1301 S 550 W
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-9173
Mailing Address - Country:US
Mailing Address - Phone:801-319-5095
Mailing Address - Fax:
Practice Address - Street 1:96 E KIMBALLS LN STE 100
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5021
Practice Address - Country:US
Practice Address - Phone:801-319-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0294124-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTPRA04893OtherMOLINA
UT56221OtherHEALTHY U
UTQM0000076595OtherALTIUS
UT107004477101OtherIHC
UT190382600OtherUS DEPT OF LABOR
UT870525882RIDOtherEDUCATORS MUTUAL