Provider Demographics
NPI:1578773297
Name:MEYERS, CAROLE G (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:G
Last Name:MEYERS
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 1:1512 147TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:ND
Mailing Address - Zip Code:58035-9415
Mailing Address - Country:US
Mailing Address - Phone:701-488-2749
Mailing Address - Fax:
Practice Address - Street 1:1512 147TH AVE SE
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:ND
Practice Address - Zip Code:58035-9415
Practice Address - Country:US
Practice Address - Phone:701-488-2749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR14071367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered