Organization
DYNAMIC ANESTHESIA, PLLC
Active
Organization
DYNAMIC ANESTHESIA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY CATHERINE DEFEO CRNA, FNP-BC (OWNER)
(603) 387-4523
Entity
Organization
Contact information
Practice address
1564 BROWNFIELD RD, CENTER CONWAY, NH 03813
(603) 387-4523
(866) 394-0351
Mailing address
1564 BROWNFIELD RD, CENTER CONWAY, NH 03813
(603) 387-4523
(866) 394-0351
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
047170-23-11
NH
367500000X
Certified Registered Nurse Anesthetist
04717023-11
NH
367500000X
Certified Registered Nurse Anesthetist
Primary
—
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3079830
—
NH
Enumeration date
09/14/2007
Last updated
06/03/2020
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