MEDICARE: MR. KURT R GABRIELSON 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
1	367500000X	Certified Registered Nurse Anesthetist	APN.0005687-CRNA	CO
2	367500000X	Certified Registered Nurse Anesthetist	R1261534	MN

General Provider Information

NPI Number	:	1417923913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KURT R GABRIELSON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 913001
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80291-3001
Country	:	US
Telephone Number	:	817-334-0530
Fax Number	:	817-877-0350

Provider Business Practice Location Address
First Line	:	320 BEARD CREEK RD STE 100
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-6426
Country	:	US
Telephone Number	:	970-569-7400
Fax Number	:	817-877-0350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	02/12/2019

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