MEDICARE: DEBORAH ANN GOTZMAN C.R.N.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN239432L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063410017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ANN GOTZMAN C.R.N.A.

Provider Business Mailing Address
First Line	:	4452 EASTGATE BLVD
Second Line	:	STE 305
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1584
Country	:	US
Telephone Number	:	215-545-4173
Fax Number	:	215-545-1543

Provider Business Practice Location Address
First Line	:	2139 AUBURN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2906
Country	:	US
Telephone Number	:	513-585-2422
Fax Number	:	513-585-3245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/22/2022

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