Healthcare Provider Details

I. General information

NPI: 1013916782
Provider Name (Legal Business Name): DENNIS VERA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DENNIS GUTIERREZ CRNA

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E 32ND ST
SILVER CITY NM
88061-7251
US

IV. Provider business mailing address

209 S MAIN ST
POPLAR BLUFF MO
63901-5831
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-4000
  • Fax:
Mailing address:
  • Phone: 573-686-5550
  • Fax: 573-686-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR46045
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: