Healthcare Provider Details

I. General information

NPI: 1063410017
Provider Name (Legal Business Name): DEBORAH ANN GOTZMAN C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

4452 EASTGATE BLVD STE 305
CINCINNATI OH
45245-1584
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-2422
  • Fax: 513-585-3245
Mailing address:
  • Phone: 215-545-4173
  • Fax: 215-545-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN239432L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: