Healthcare Provider Details

I. General information

NPI: 1194899179
Provider Name (Legal Business Name): DENNIS GERARD DEAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19363 WILLAMETTE DR #191
WEST LINN OR
97068-2010
US

IV. Provider business mailing address

19363 WILLAMETTE DR #191
WEST LINN OR
97068-2010
US

V. Phone/Fax

Practice location:
  • Phone: 971-404-5559
  • Fax: 503-699-8792
Mailing address:
  • Phone: 971-404-5559
  • Fax: 503-699-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: