Healthcare Provider Details

I. General information

NPI: 1598942740
Provider Name (Legal Business Name): DEANNA YVONNE HITCHENS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E LAKE SHORE DR
DECATUR IL
62521-3810
US

IV. Provider business mailing address

2605 TIMBER RIDGE DR
DECATUR IL
62521-9581
US

V. Phone/Fax

Practice location:
  • Phone: 217-464-2966
  • Fax:
Mailing address:
  • Phone: 217-413-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.007070041.309468
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-309468
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: