Healthcare Provider Details

I. General information

NPI: 1710409073
Provider Name (Legal Business Name): ABRAHAM ROMRELL ANDERSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ABE ROMRELL ANDERSON CRNA

II. Dates (important events)

Enumeration Date: 07/08/2017
Last Update Date: 07/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LEOTA ST
NORTH PLATTE NE
69101-6525
US

IV. Provider business mailing address

601 W LEOTA ST
NORTH PLATTE NE
69101-6525
US

V. Phone/Fax

Practice location:
  • Phone: 308-568-8820
  • Fax: 308-535-3448
Mailing address:
  • Phone: 208-716-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101429
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: