Healthcare Provider Details

I. General information

NPI: 1851340301
Provider Name (Legal Business Name): DENISE S DEPPEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BAY PARK DR
OREGON OH
43616-4920
US

IV. Provider business mailing address

2801 BAY PARK DR
OREGON OH
43616-4920
US

V. Phone/Fax

Practice location:
  • Phone: 419-690-7653
  • Fax: 419-697-7726
Mailing address:
  • Phone: 419-690-7653
  • Fax: 419-697-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704170733
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.13922-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: