Provider Demographics
NPI:1255374104
Name:DEPTULSKI, NANCY P (CRNA)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:P
Last Name:DEPTULSKI
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 1:3084 12TH AVE SE UNIT 107
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9829
Mailing Address - Country:US
Mailing Address - Phone:860-634-4449
Mailing Address - Fax:
Practice Address - Street 1:15 BROOKSIDE LNDG
Practice Address - Street 2:ATTN NANCY DEPTULSKI
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-2340
Practice Address - Country:US
Practice Address - Phone:860-634-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7077367500000X
NC119908367500000X
CT1765367500000X
CT001765367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1486Medicaid
VTOVN1486Medicaid
VTOVN1486Medicaid