Provider Demographics
NPI:1851621676
Name:DEAN, MARYANN B (CRNA)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:B
Last Name:DEAN
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:PO BOX 851417
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-1417
Mailing Address - Country:US
Mailing Address - Phone:251-342-3000
Mailing Address - Fax:251-342-3043
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-342-3000
Practice Address - Fax:251-342-3043
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1102362367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL116259OtherMEDICAID AOC
AL51102137OtherBCBS OF AL SMC
AL51102138OtherBCBS OF AL AOC
AL116346Medicaid