Provider Demographics
NPI:1477647527
Name:SEFTON, DYAN L (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DYAN
Middle Name:L
Last Name:SEFTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:L
Other - Last Name:SEFTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:4680 OLD FOREST RD SW
Mailing Address - Street 2:PO BOX 952
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-6437
Mailing Address - Country:US
Mailing Address - Phone:812-738-7606
Mailing Address - Fax:812-634-7152
Practice Address - Street 1:2200 MARKET ST
Practice Address - Street 2:C/O SAINT CATHERINE'S REGIONAL HOSPITAL
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9553
Practice Address - Country:US
Practice Address - Phone:812-256-7679
Practice Address - Fax:812-256-7419
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28104181A207QA0401X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200103090BMedicaid
IN28104181AOtherIN LICENSE NUMBER
IL430072300OtherMEDICARE RAILROAD #
IN1467530931OtherSEFTON ANESTHESIA SERVICES GROUP NPI#
IN000000286565OtherABCBS PROVIDER #
IL430072300OtherMEDICARE RAILROAD #
INCB9210Medicare PIN