Healthcare Provider Details

I. General information

NPI: 1518299940
Provider Name (Legal Business Name): DAVID GERARD HEAD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARY STREET
EVANSVILLE IN
47747-2514
US

IV. Provider business mailing address

800 W 9TH ST
JASPER IN
47546-2514
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-2240
  • Fax: 812-450-2710
Mailing address:
  • Phone: 812-996-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28137879A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: