Healthcare Provider Details

I. General information

NPI: 1801149190
Provider Name (Legal Business Name): ERICH KARL DEASON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 CHERRY ST
TOLEDO OH
43608-2792
US

IV. Provider business mailing address

2409 CHERRY ST SUITE 305
TOLEDO OH
43608-2792
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-3232
  • Fax:
Mailing address:
  • Phone: 419-251-3740
  • Fax: 419-251-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.13991
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: