Healthcare Provider Details

I. General information

NPI: 1033394978
Provider Name (Legal Business Name): DONNA MICHELLE DEAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 MEDICAL PARK DR # B
BILOXI MS
39532-2131
US

IV. Provider business mailing address

9202 ROCK HILL RD
VANCLEAVE MS
39565-8676
US

V. Phone/Fax

Practice location:
  • Phone: 228-702-2000
  • Fax:
Mailing address:
  • Phone: 228-219-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-108593
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number851224
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: