Individual
DAVID CARABALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1221 SOUTH DR, MT PLEASANT, MI 48858-3257
(989) 772-6700
(989) 772-6807
Mailing address
1221 SOUTH DR, MT PLEASANT, MI 48858-3257
(989) 772-6700
(989) 772-6807
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704244370
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704244370
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704244370
STATE LICENSE
MI
Enumeration date
02/18/2011
Last updated
04/11/2011
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