Healthcare Provider Details

I. General information

NPI: 1558488114
Provider Name (Legal Business Name): JENNA DUNDAS DEBRABANT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SMITH RD
CINCINNATI OH
45212-2787
US

IV. Provider business mailing address

200 NORTHLAND BLVD 1ST FLOOR
CINCINNATI OH
45246-3604
US

V. Phone/Fax

Practice location:
  • Phone: 513-672-3300
  • Fax: 513-672-3323
Mailing address:
  • Phone: 513-672-3300
  • Fax: 513-672-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.09245-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: