| NPI | 1124058896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIA DECKER Office Manager 270-782-9994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2010-01-27 |