MEDICARE: CHRISTINE LOUISE DEATLEY CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN536140	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962474585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LOUISE DEATLEY CRNA

Provider Business Mailing Address
First Line	:	20207 RAINBOW DRIVE
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031
Country	:	US
Telephone Number	:	724-513-2657
Fax Number	:

Provider Business Practice Location Address
First Line	:	10030 GILEAD RD
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7545
Country	:	US
Telephone Number	:	704-316-4875
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	05/06/2013

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