Individual
MS. ELIZABETH GILLUM WENTLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
408 N MAIN ST FL 2, PUEBLO, CO 81003
(719) 584-4000
Mailing address
PO BOX 560825, DENVER, CO 80256-0825
(719) 595-7580
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
249005
TX
367500000X
Certified Registered Nurse Anesthetist
APRN11035876
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033426000
—
FL
01
—
G0084
BCBS
FL
Enumeration date
08/28/2007
Last updated
01/06/2025
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