Individual
DALETTE ANN CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
104 W 1ST ST, JULESBURG, CO 80737-1502
(316) 613-1994
Mailing address
104 W 1ST ST, JULESBURG, CO 80737-1502
(316) 613-1994
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
55014
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100405110C
—
KS
01
—
145393
BCBS
KS
01
—
P00398982
RR MEDICARE GROUP CQ2302
KS
Enumeration date
11/08/2006
Last updated
07/25/2016
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