Healthcare Provider Details

I. General information

NPI: 1396815619
Provider Name (Legal Business Name): DALETTE ANN CARLSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DALETTE ANN FESLER

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 1ST ST
JULESBURG CO
80737-1502
US

IV. Provider business mailing address

104 W 1ST ST
JULESBURG CO
80737-1502
US

V. Phone/Fax

Practice location:
  • Phone: 316-613-1994
  • Fax:
Mailing address:
  • Phone: 316-613-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55014
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: