Healthcare Provider Details

I. General information

NPI: 1649203209
Provider Name (Legal Business Name): DONALD A DESALVO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 E FRANK PHILLIPS BLVD
BARTLESVILLE OK
74006-2411
US

IV. Provider business mailing address

PO BOX 3456
BARTLESVILLE OK
74006-3456
US

V. Phone/Fax

Practice location:
  • Phone: 918-331-1555
  • Fax: 918-333-1695
Mailing address:
  • Phone: 918-333-4100
  • Fax: 918-333-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number680876
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 88186
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: