Healthcare Provider Details

I. General information

NPI: 1902871601
Provider Name (Legal Business Name): DARLA G. BUSSEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30684 OBANION LN
PRATHER CA
93651-9633
US

IV. Provider business mailing address

30684 O'BANION LANE
PRATHER CA
93651
US

V. Phone/Fax

Practice location:
  • Phone: 559-855-3326
  • Fax:
Mailing address:
  • Phone: 559-855-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA2058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: