Provider Demographics
NPI:1407126220
Name:FAIRCHILD, DALILA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DALILA
Middle Name:
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 UMPTANUM RD
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-6989
Mailing Address - Country:US
Mailing Address - Phone:509-899-9083
Mailing Address - Fax:
Practice Address - Street 1:5241 UMPTANUM RD
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-6989
Practice Address - Country:US
Practice Address - Phone:509-899-9083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200841072367500000X
WAAP60292819367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered