Glen Deitrick is a Gulfport, Mississippi based nurse anesthetist who is specialized as Anesthesia Administration nurse. Active license number of Glen Deitrick is R128610 for Anesthesia Administration in Mississippi. his current practice location is 15190 Community Rd, Suite 230a, Gulfport. Patients can reach him at 228-831-0204 or can fax him at 228-831-1868. Glen Deitrick is C.R.N.A with specialization in Anesthesia Administration and he NPI number (Unique professional ID assigned by NPPES) is 1033214564. Glen Deitrick is a certified registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists.
Complete Profile:
Glen Deitrick speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
Specialization:
Anesthesia Administration
Credentials:
C.R.N.A
Gender:
Male
Practice Address:
15190 Community Rd, Suite 230a, Gulfport, Mississippi, 39503-3485
Phone:
228-831-0204
Fax:
228-831-1868
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
NPI Number:
1033214564
NPI Enumeration Date:
13 Sep, 2006
NPI Last Update On:
08 Jul, 2007
Medical Licenses:
Nurses can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Glen Deitrick are as mentioned below.
License Number
Specialization
State
Status
R128610
Anesthesia Administration
Mississippi
Primary
Other Medical Identifiers:
Other legacy medical identifiers associated with Glen Deitrick such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
00111157
Medicaid
Mississippi
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
15190 Community Rd, Suite 230a Gulfport, Mississippi
Zip:
39503-3485
Phone Number:
228-831-0204
Fax Number:
228-831-1868
Patients can reach Glen Deitrick at 15190 Community Rd, Suite 230a, Gulfport, Mississippi or can call to book an appointment on 228-831-0204.
Comments/ Reviews:
Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 10 March, 2025.