| Glen Deitrick, CRNA | |
|
15190 Community Rd, Suite 230a, Gulfport, MS 39503-3485 | |
| (228) 831-0204 | |
| (228) 831-1868 |
| Full Name | Glen Deitrick |
|---|---|
| Gender | Male |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 15190 Community Rd, Gulfport, Mississippi |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033214564 | NPI | - | NPPES |
| 00111157 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | R128610 (Mississippi) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Glen Deitrick, CRNA 15190 Community Rd, Suite 230a, Gulfport, MS 39503-3485 Ph: (228) 831-0204 | Glen Deitrick, CRNA 15190 Community Rd, Suite 230a, Gulfport, MS 39503-3485 Ph: (228) 831-0204 |
Kathryn Pittman, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 15200 Community Rd, Gulfport, MS 39503 Phone: 228-575-7000 | |
Jason Wells, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4500 13th St, Gulfport, MS 39501 Phone: 228-865-3281 Fax: 228-867-5117 | |
Victor P Polito, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 15190 Community Rd, Suite 230a, Gulfport, MS 39503 Phone: 228-831-0204 Fax: 228-831-1868 | |
Glen Michael Cavalier, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 15200 Community Rd, Gulfport, MS 39503 Phone: 228-575-7000 | |
Julie K Klester, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 15190 Community Rd, Suite 230a, Gulfport, MS 39503 Phone: 228-831-0204 Fax: 228-831-1868 | |
Trinh Thu Weatherly, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4500 13th St, Gulfport, MS 39501 Phone: 228-867-4000 |