Provider Demographics
NPI:1669423935
Name:BISALSKI, HAMPTON (CRNA)
Entity type:Individual
Prefix:MR
First Name:HAMPTON
Middle Name:
Last Name:BISALSKI
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 1:13330 DILLON ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-7200
Mailing Address - Country:US
Mailing Address - Phone:970-380-0717
Mailing Address - Fax:303-659-9579
Practice Address - Street 1:13330 DILLON ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-7200
Practice Address - Country:US
Practice Address - Phone:970-380-0717
Practice Address - Fax:303-659-9579
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-129854367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79982352Medicaid