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General NPI Number Information
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NPI Number | 1295921112
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Entity Type | Individual
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Provider Name | GLENN DEAN CARLTON CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 04/26/2026
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Provider Practice Location Address
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Address Line | 621 W PINE ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-5042
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Country | US
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Telephone | 573-686-4111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 88
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City | POPLAR BLUFF
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State | MO
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Zip | 63902-0088
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Country | US
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Telephone | 573-727-2724
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Fax | 573-727-2788
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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 | 2005036504
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License Number State | MO
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