Individual
LEVI COLTER BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
117 E 19TH ST, ROSWELL, NM 88201-5151
(814) 877-2137
Mailing address
530B HARKLE RD STE 100, SANTA FE, NM 87505-4739
(480) 254-1430
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA0680
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508185760
—
AZ
05
—
528136
—
AZ
Enumeration date
05/26/2010
Last updated
07/05/2021
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