Provider Demographics
NPI:1790840023
Name:CREPPS, VICKY ANNE (RN, MS, CRNA)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:ANNE
Last Name:CREPPS
Suffix:
Gender:F
Credentials:RN, MS, CRNA
Other - Prefix:MRS
Other - First Name:VICKY
Other - Middle Name:ANNE
Other - Last Name:CREPPS-DENNY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MS, CRNA
Mailing Address - Street 1:975 SERENO DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2441
Mailing Address - Country:US
Mailing Address - Phone:707-651-1000
Mailing Address - Fax:
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:707-651-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA073092367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01515ZMedicare ID - Type Unspecified
CAQ40616Medicare UPIN