Provider Demographics
NPI:1558488114
Name:DEBRABANT, JENNA DUNDAS (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:DUNDAS
Last Name:DEBRABANT
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 1:200 NORTHLAND BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3604
Mailing Address - Country:US
Mailing Address - Phone:513-672-3300
Mailing Address - Fax:513-672-3323
Practice Address - Street 1:4700 SMITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2787
Practice Address - Country:US
Practice Address - Phone:513-672-3300
Practice Address - Fax:513-672-3323
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09245-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2787884Medicaid
OH8242801Medicare PIN