Basic Information
| Provider Information | |||||||||
| NPI: | 1104083344 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AGNOLETTO ANESTHESIA , INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2994 | ||||||||
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| City: | EDWARDS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816322994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034229438 | ||||||||
| FaxNumber: | 3034229474 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 W BEAVER CREEK BLVD | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034229438 | ||||||||
| FaxNumber: | 3034229474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | AGNOLETTO | ||||||||
| AuthorizedOfficialFirstName: | SALLY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3034229438 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 95481 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.