Provider Demographics
NPI:1588683205
Name:BAUSTERT, DEAN A I (CRNA)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:BAUSTERT
Suffix:I
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 N DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2609
Mailing Address - Country:US
Mailing Address - Phone:405-979-8046
Mailing Address - Fax:405-979-8047
Practice Address - Street 1:1111 N DEWEY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2609
Practice Address - Country:US
Practice Address - Phone:405-979-8046
Practice Address - Fax:405-979-8047
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0045865367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered