Healthcare Provider Details

I. General information

NPI: 1417251232
Provider Name (Legal Business Name): DAMIUN BASSANDEH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2011
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S 19TH ST
NEVADA IA
50201
US

IV. Provider business mailing address

1111 NE 15TH LN
ANKENY IA
50021-6561
US

V. Phone/Fax

Practice location:
  • Phone: 515-382-2111
  • Fax:
Mailing address:
  • Phone: 405-315-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD148781
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: