Provider Demographics
NPI:1013528322
Name:CANTERBURY, DEANNA DRUE (RN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:DRUE
Last Name:CANTERBURY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:DRUE
Other - Last Name:ISTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1203 N 207TH CIR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-6979
Mailing Address - Country:US
Mailing Address - Phone:402-661-9445
Mailing Address - Fax:
Practice Address - Street 1:2235 S 46TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3304
Practice Address - Country:US
Practice Address - Phone:531-299-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57563163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse