Basic Information
| Provider Information | |||||||||
| NPI: | 1154658094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEEL | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | DARRELL | ||||||||
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| Credential: | RN, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 213 S JEFFERSON ST | ||||||||
| Address2: | SUITE 625 | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240111700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402245688 | ||||||||
| FaxNumber: | 5402245684 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 LAMB CIR | ||||||||
| Address2: | |||||||||
| City: | CHRISTIANSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240736344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407312800 | ||||||||
| FaxNumber: | 5407312874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2009 | ||||||||
| LastUpdateDate: | 01/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 0024168621 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | 0001162087 | VA | N | Nursing Service Providers | Registered Nurse |
No ID Information.