Healthcare Provider Details

I. General information

NPI: 1366615015
Provider Name (Legal Business Name): GWENETH MILLEN DELLETT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

IV. Provider business mailing address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

V. Phone/Fax

Practice location:
  • Phone: 814-534-3931
  • Fax: 814-534-9715
Mailing address:
  • Phone: 814-534-3931
  • Fax: 814-534-9715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN331386L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: