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General NPI Number Information
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NPI Number | 1962474585
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Entity Type | Individual
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Provider Name | CHRISTINE LOUISE DEATLEY CRNA
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Gender | Female
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 10030 GILEAD RD
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-7545
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Country | US
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Telephone | 704-316-4875
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Fax |
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Provider Business Mailing Address
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Address Line | 20207 RAINBOW DRIVE
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City | CORNELIUS
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State | NC
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Zip | 28031
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Country | US
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Telephone | 724-513-2657
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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 | RN536140
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License Number State | PA
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