Organization
DRIFT AWAY ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE M CARLSON CRNA (MBR)
(573) 718-0902
Entity
Organization
Contact information
Practice address
1200 JOHN Q HAMMONS DR STE 102, MADISON, WI 53717-1967
(573) 686-5550
Mailing address
1877 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2833
(573) 785-4601
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
06/21/2016
Last updated
04/03/2026
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