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General NPI Number Information
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NPI Number | 1952596751
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Entity Type | Organization
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Legal Business Name | DYNAMIC ANESTHESIA, PLLC
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 1564 BROWNFIELD RD
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City | CENTER CONWAY
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State | NH
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Zip | 03813
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Country | US
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Telephone | 603-387-4523
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Fax | 866-394-0351
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Provider Business Mailing Address
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Address Line | 1564 BROWNFIELD RD
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City | CENTER CONWAY
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State | NH
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Zip | 03813
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Country | US
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Telephone | 603-387-4523
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Fax | 866-394-0351
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Authorized Official
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Title or Position | OWNER
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Name | MS. KELLY CATHERINE DEFEO
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Credential | CRNA, FNP-BC
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Telephone | 603-387-4523
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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 | 04717023-11
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 047170-23-11
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State | NH
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