Provider Demographics
NPI:1598794190
Name:DILLEHAY, REX LAWRENCE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:REX
Middle Name:LAWRENCE
Last Name:DILLEHAY
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 1:1828 CHIANTI CT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-9700
Mailing Address - Country:US
Mailing Address - Phone:806-341-2545
Mailing Address - Fax:
Practice Address - Street 1:1828 CHIANTI CT
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-9700
Practice Address - Country:US
Practice Address - Phone:806-341-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229360367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered