Individual
DALLIN LEE BRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 688-1000
Mailing address
2001 W LAKEWAY RD, GILLETTE, WY 82718-5773
(307) 689-9772
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28057.1046
WY
Other
Enumeration date
04/09/2010
Last updated
10/27/2010
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