Healthcare Provider Details

I. General information

NPI: 1902947344
Provider Name (Legal Business Name): CARL ERIC OSLUND CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LACEY ST
CAPE GIRARDEAU MO
63701-5230
US

IV. Provider business mailing address

2214 EARLEEN ST
CAPE GIRARDEAU MO
63701-1812
US

V. Phone/Fax

Practice location:
  • Phone: 573-651-5562
  • Fax:
Mailing address:
  • Phone: 573-335-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number126873
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: