Provider Demographics
NPI:1992869598
Name:BELL, JEFFREY LOGAN (CRNA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LOGAN
Last Name:BELL
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 1:1180 N WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1353
Mailing Address - Country:US
Mailing Address - Phone:801-513-5342
Mailing Address - Fax:
Practice Address - Street 1:1180 N WINSTON DR
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1353
Practice Address - Country:US
Practice Address - Phone:801-513-5342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166176367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006223D83Medicare ID - Type Unspecified