Healthcare Provider Details

I. General information

NPI: 1528147055
Provider Name (Legal Business Name): CHRIS JOHN MARSHALL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 3RD ST
DELTA CO
81416-2815
US

IV. Provider business mailing address

PO BOX 1121
DELTA CO
81416-1121
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-7681
  • Fax:
Mailing address:
  • Phone: 970-874-5346
  • Fax: 970-874-5346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number75154
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: