Healthcare Provider Details

I. General information

NPI: 1164888087
Provider Name (Legal Business Name): CURTIS NIELSEN CRNA, DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 S HULEN ST SUITE 425
FORT WORTH TX
76109-4914
US

IV. Provider business mailing address

3410 RIVERSTONE CIR E APT 311
FORT WORTH TX
76116-0878
US

V. Phone/Fax

Practice location:
  • Phone: 817-731-2875
  • Fax:
Mailing address:
  • Phone: 801-710-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP129997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: