Healthcare Provider Details

I. General information

NPI: 1003204074
Provider Name (Legal Business Name): CDEU ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 S QUEEN ST SUITE 105
DOVER DE
19904-3543
US

IV. Provider business mailing address

401 COMMERCE ST SUITE 600
NASHVILLE TN
37219-2446
US

V. Phone/Fax

Practice location:
  • Phone: 302-677-1617
  • Fax:
Mailing address:
  • Phone: 615-345-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JEFFREY R FISHER
Title or Position: CFO
Credential:
Phone: 615-345-6900