Healthcare Provider Details

I. General information

NPI: 1265476246
Provider Name (Legal Business Name): DANA L DIMARCO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA L CUNNINGHAM CRNA

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6819 PLUM CREEK DR
AMARILLO TX
79124-1602
US

IV. Provider business mailing address

PO BOX 140677
DALLAS TX
75214-0677
US

V. Phone/Fax

Practice location:
  • Phone: 806-354-6100
  • Fax: 806-352-0381
Mailing address:
  • Phone: 214-522-0210
  • Fax: 214-522-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number571641
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: