Provider Demographics
NPI:1356648828
Name:CARABALLO, DAVID (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3257
Mailing Address - Country:US
Mailing Address - Phone:989-772-6700
Mailing Address - Fax:989-772-6807
Practice Address - Street 1:1221 SOUTH DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3257
Practice Address - Country:US
Practice Address - Phone:989-772-6700
Practice Address - Fax:989-772-6807
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244370163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704244370OtherSTATE LICENSE