Provider Demographics
NPI:1538135025
Name:ROBERTSON, DALE J (CRNA)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:J
Last Name:ROBERTSON
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:PO BOX 10925
Mailing Address - Street 2:BAY ANESTHESIA ASSOCIATES
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19850-0925
Mailing Address - Country:US
Mailing Address - Phone:302-674-4700
Mailing Address - Fax:
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:BAY ANESTHESIA ASSOCIATES
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-674-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL60A00462367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEL6-0A00462OtherPROFESSIONAL LICENSE-CRNA
DEL1-0015899OtherPROFESSIONAL LICENSE-RN