Provider Demographics
NPI:1407843253
Name:DARNIELLE, CHRISTINE T (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:T
Last Name:DARNIELLE
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 1:45 CENTAURUS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7912
Mailing Address - Country:US
Mailing Address - Phone:928-274-2445
Mailing Address - Fax:
Practice Address - Street 1:45 CENTAURUS RANCH RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-7912
Practice Address - Country:US
Practice Address - Phone:928-274-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX503146367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033052OtherRECERTIFICATION AANA
TX85251UOtherBLUE CROSS BLUE SHIELD
TX137080115Medicaid
R92878Medicare UPIN
TX8D6146Medicare ID - Type Unspecified