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General NPI Number Information
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NPI Number | 1851393623
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Entity Type | Individual
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Provider Name | GARY A DERAAD CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-7001
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Country | US
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Telephone | 859-323-5956
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Fax | 859-323-1080
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Provider Business Mailing Address
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Address Line | 26699 MOHAWK DR
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City | PERRYSBURG
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State | OH
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Zip | 43551-5403
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Country | US
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Telephone | 419-690-7652
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Fax | 419-697-7726
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3004238
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN 279724
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License Number State | OH
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