Healthcare Provider Details

I. General information

NPI: 1942986195
Provider Name (Legal Business Name): VINCENT ERNEST DIVENTI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VINCENT ERNEST DIVENTI CRNA

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 819 BOX 18
FPO AE
09645-0001
US

IV. Provider business mailing address

PSC 819 BOX 18
FPO AE
09645-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-727-3524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7195
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: