Provider Demographics
NPI:1245227396
Name:DEENER, JOAN M (CRNA)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:DEENER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2742
Mailing Address - Country:US
Mailing Address - Phone:502-458-7400
Mailing Address - Fax:502-458-7449
Practice Address - Street 1:3101 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 1A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2742
Practice Address - Country:US
Practice Address - Phone:502-458-7400
Practice Address - Fax:502-458-7449
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1030400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2436422000OtherPASSPORT ADVANTAGE
KY000000283599OtherANTHEM BLUE SHIELD
KY1104961OtherPASSPORT
KY74324948Medicaid
KY430008599OtherRAILROAD MEDICARE
KY1269924Medicare PIN