Individual
DEREK S POULSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
57809 HILLSIDE DR, GOSHEN, IN 46528-4402
(801) 623-7813
Mailing address
57809 HILLSIDE DR, GOSHEN, IN 46528-4402
(801) 623-7813
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AA103025
ME
Other
Enumeration date
12/08/2010
Last updated
11/18/2013
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