Organization
MOUNTAIN VALLEY ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA DUPUY HERRERO CRNA (MEMBER)
(864) 915-1878
Entity
Organization
Contact information
Practice address
750 HOSPITAL LOOP, CRAIG, CO 81625-8750
(918) 850-5607
Mailing address
PO BOX 1241, CLARK, CO 80428-1241
(864) 915-1878
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C-APN.0000708-C-CRNA
CO
Other
Enumeration date
07/17/2018
Last updated
07/17/2018
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