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General NPI Number Information
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NPI Number | 1164888087
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Entity Type | Individual
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Provider Name | CURTIS NIELSEN CRNA, DNP
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Gender | Male
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 4200 S HULEN ST SUITE 425
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City | FORT WORTH
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State | TX
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Zip | 76109-4914
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Country | US
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Telephone | 817-731-2875
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Fax |
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Provider Business Mailing Address
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Address Line | 3410 RIVERSTONE CIR E APT 311
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City | FORT WORTH
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State | TX
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Zip | 76116-0878
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Country | US
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Telephone | 801-710-5607
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP129997
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License Number State | TX
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