MEDICARE: MR. BRYAN KEITH DEHNER NURSE ANESTHETIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	667489	CA
2	367500000X	Certified Registered Nurse Anesthetist	178376-030	WI
3	367500000X	Certified Registered Nurse Anesthetist	209.008888	IL
4	367500000X	Certified Registered Nurse Anesthetist	APRN.CRNA.019935	OH

General Provider Information

NPI Number	:	1285771634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN KEITH DEHNER NURSE ANESTHETIST

Provider Business Mailing Address
First Line	:	3050 TRAIL CREST LN
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-4999
Country	:	US
Telephone Number	:	619-384-9013
Fax Number	:

Provider Business Practice Location Address
First Line	:	2607 SAINT ANNE WAY
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-3895
Country	:	US
Telephone Number	:	619-384-9013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	09/11/2019

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