Provider Demographics
NPI:1396815619
Name:CARLSON, DALETTE ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:DALETTE
Middle Name:ANN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DALETTE
Other - Middle Name:ANN
Other - Last Name:FESLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JULESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80737-1502
Mailing Address - Country:US
Mailing Address - Phone:316-613-1994
Mailing Address - Fax:
Practice Address - Street 1:104 W 1ST ST
Practice Address - Street 2:
Practice Address - City:JULESBURG
Practice Address - State:CO
Practice Address - Zip Code:80737-1502
Practice Address - Country:US
Practice Address - Phone:316-613-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55014367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS145393OtherBCBS
KS100405110CMedicaid
KSP00398982OtherRR MEDICARE GROUP CQ2302
KS145393OtherBCBS