Provider Demographics
NPI:1851340301
Name:DEPPEN, DENISE S (CRNA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:S
Last Name:DEPPEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-4920
Mailing Address - Country:US
Mailing Address - Phone:419-690-7653
Mailing Address - Fax:419-697-7726
Practice Address - Street 1:2801 BAY PARK DR
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4920
Practice Address - Country:US
Practice Address - Phone:419-690-7653
Practice Address - Fax:419-697-7726
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704170733367500000X
OHCOA.13922-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH42636OtherAANA
MIN97820011Medicare ID - Type Unspecified