Provider Demographics
NPI:1710973078
Name:DZYBAN, STEVEN M (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:DZYBAN
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:PO BOX 3062
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024
Mailing Address - Country:US
Mailing Address - Phone:615-972-0366
Mailing Address - Fax:
Practice Address - Street 1:5204 RAVENS GLN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8596
Practice Address - Country:US
Practice Address - Phone:615-332-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN11946207L00000X
TNAPN10101367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3626175Medicare ID - Type Unspecified
TN103I432118Medicare UPIN