Provider Demographics
NPI:1477522670
Name:DEPIES, LAREE C (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LAREE
Middle Name:C
Last Name:DEPIES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:LOREE
Other - Middle Name:C
Other - Last Name:SCHUMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 MERCY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1833
Mailing Address - Country:US
Mailing Address - Phone:231-733-1326
Mailing Address - Fax:231-733-5212
Practice Address - Street 1:1400 MERCY DR STE 100
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1833
Practice Address - Country:US
Practice Address - Phone:231-733-1326
Practice Address - Fax:231-733-5212
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704229397367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4718235Medicaid
MILD229397OtherBCBS LICENSE NUMBER
MI430D110990OtherBCBS GROUP BILL PIN
MIP00183821OtherRAILROAD MEDICARE
MI0876504OtherBCBS PIN
MICE1952OtherRAILROAD GROUP
MI430D110990OtherBCBS GROUP BILL PIN
MIP19731Medicare UPIN