Glen Deitrick, C.R.N.A
NPI #1033214564 in Gulfport, Mississippi
Provider Information
- NPI Number
- 1033214564
- Entity Type
- Individual
- Name
- Glen Deitrick, C.R.N.A
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Nurse Anesthetist, Certified Registered
- Credential
- C.R.N.A
- Enumeration Date
- Sep 13, 2006
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 15190 COMMUNITY RD
- Address 2
- SUITE 230A
- City
- Gulfport
- State
- Mississippi
- ZIP Code
- 39503-3485
- Phone
- (228) 831-0204
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Anesthetist, Certified Registered |
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