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NPI Code Detail

MEDICARE: DENNIS VERA CRNA

MEDICARE: DENNIS VERA CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistR46045NM

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2430064431OTHERNMRAILROAD MEDICARE INDIVID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3NM006778OTHERNMINDIVIDUAL BCBS NM
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013916782
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENNIS VERA CRNA
Provider Business Mailing Address
First Line : 209 S MAIN ST
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-5831
Country : US
Telephone Number : 573-686-5550
Fax Number : 573-686-2139
Provider Business Practice Location Address
First Line : 1313 E 32ND ST
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-7251
Country : US
Telephone Number : 575-538-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 07/17/2019

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