Provider Demographics
NPI:1801193743
Name:LEE, DEANNA M (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:M
Other - Last Name:DIPILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5151 REED RD
Mailing Address - Street 2:SUITE 225-C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2595
Mailing Address - Country:US
Mailing Address - Phone:614-457-2306
Mailing Address - Fax:614-884-0776
Practice Address - Street 1:5151 REED RD
Practice Address - Street 2:SUITE 225-C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2595
Practice Address - Country:US
Practice Address - Phone:614-457-2306
Practice Address - Fax:614-884-0776
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA12117NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3134745Medicaid
OHRN318456OtherRN OHIO LICENSE
OH8249431Medicare PIN
OH3134745Medicaid