Healthcare Provider Details

I. General information

NPI: 1255374104
Provider Name (Legal Business Name): NANCY P. DEPTULSKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BROOKSIDE LNDG ATTN NANCY DEPTULSKI
PUTNAM CT
06260-2340
US

IV. Provider business mailing address

3084 12TH AVE SE UNIT 107
HICKORY NC
28602-9829
US

V. Phone/Fax

Practice location:
  • Phone: 860-634-4449
  • Fax:
Mailing address:
  • Phone: 860-634-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7077
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number119908
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: