Glen Deitrick C.R.N.A

NPI 1033214564 - Nurse Anesthetist, Certified Registered - 367500000X

NPI Details
NPI 1033214564
Gender Male
Enumeration Date 09/13/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
15190 COMMUNITY RD
SUITE 230A
GULFPORT MS, 39503-3485, US
Phone (228) 831-0204
Fax (228) 831-1868
Business Location
15190 COMMUNITY RD
SUITE 230A
GULFPORT MS, 39503-3485, US
Phone (228) 831-0204
Fax (228) 831-1868
Toxanomy
Taxonomy Code 367500000X
License State Mississippi
License Number R128610
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According to our database, Glen Deitrick C.R.N.A NPI is 1033214564, taxonomy code is 367500000X and license number is R128610, license state is located at Mississippi. Glen Deitrick C.R.N.A physically located at 15190 Community Rd, Gulfport MS, 39503-3485. NPI Number Glen Deitrick C.R.N.A has the Individual type.

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1033214564 NPI number is provided on an as is basis without warranty of any kind. 1033214564 is maintained by the National Plan & Provider Enumeration System. The contents of Glen Deitrick C.R.N.A are for informational purposes only.