Provider Demographics
NPI:1417251232
Name:BASSANDEH, DAMIUN (CRNA)
Entity Type:Individual
Prefix:
First Name:DAMIUN
Middle Name:
Last Name:BASSANDEH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 NE 15TH LN
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6561
Mailing Address - Country:US
Mailing Address - Phone:405-315-7223
Mailing Address - Fax:
Practice Address - Street 1:640 S 19TH ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201
Practice Address - Country:US
Practice Address - Phone:515-382-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD148781367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty