Provider Demographics
NPI:1790868677
Name:HEIDEMAN, DEAN A (CRNA)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:HEIDEMAN
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 1:1500 ASSOCIATES DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2201
Mailing Address - Country:US
Mailing Address - Phone:563-584-4500
Mailing Address - Fax:563-584-4525
Practice Address - Street 1:1500 ASSOCIATES DR STE 201
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2201
Practice Address - Country:US
Practice Address - Phone:563-584-4500
Practice Address - Fax:563-584-4525
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-84460-052163W00000X
IA121780163W00000X
KS55559367500000X
IAD121780367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse