DEREK S POULSON

GOSHEN, IN
NPI1033412440
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: ME  AA103025)
Enumeration Date2010-12-08
Last Update Date2013-11-18
Business Address
-- DEREK S POULSON CRNA
57809 HILLSIDE DR
GOSHEN, IN 46528-4402
Phone number: 801-623-7813
Mailing Address
-- DEREK S POULSON CRNA
57809 HILLSIDE DR
GOSHEN, IN 46528-4402
Phone number: 801-623-7813
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