Provider Demographics
NPI:1790229193
Name:FREELANCE ANESTHESIA COLORADO LLC
Entity Type:Organization
Organization Name:FREELANCE ANESTHESIA COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMALA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNAP, CRNA
Authorized Official - Phone:918-704-5556
Mailing Address - Street 1:3134 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2524
Mailing Address - Country:US
Mailing Address - Phone:207-653-9698
Mailing Address - Fax:866-550-2242
Practice Address - Street 1:18801 E MAINSTREET STE 150
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3477
Practice Address - Country:US
Practice Address - Phone:303-841-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREELANCE ANESTHESIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCRNA-01442367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty