Healthcare Provider Details

I. General information

NPI: 1205961729
Provider Name (Legal Business Name): COURTENAY M DAUMEYER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
RETTERING OH
45429
US

IV. Provider business mailing address

1 WYOMING ST
DAYTON OH
45409-2722
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-8228
  • Fax: 937-208-3843
Mailing address:
  • Phone: 937-208-6173
  • Fax: 937-208-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.02583
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA-02583
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: