NPI 1033214564

Glen Deitrick, CRNA

Practitioner Certified Registered Nurse Anesthetist Gulfport, MS

Practice location

Address: 15190 Community Rd Suite 230a, Gulfport, MS 39503-3485
Phone: (228) 831-0204
Fax: (228) 831-1868

Registered specialties

Certified Registered Nurse Anesthetist Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 367500000X Licence R128610 (MS)

Other Nurse Anesthetist, Certified Registered providers in Mississippi →

Registry record

NPI: 1033214564
Entity type: Individual
Sex (as registered): Male
NPI issued: 13 Sep 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.