Healthcare Provider Details

I. General information

NPI: 1689851131
Provider Name (Legal Business Name): AMANDA L DESCHENES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SAINT FRANCIS DR
CAPE GIRARDEAU MO
63703-5049
US

IV. Provider business mailing address

211 SAINT FRANCIS DR
CAPE GIRARDEAU MO
63703-5049
US

V. Phone/Fax

Practice location:
  • Phone: 866-230-8550
  • Fax: 913-341-5797
Mailing address:
  • Phone: 866-230-8550
  • Fax: 913-341-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2004004430
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: