Provider Demographics
NPI:1336772839
Name:HICE, DEANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:
Last Name:HICE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DEANNE
Other - Middle Name:
Other - Last Name:TERNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7522 MULLIGAN WAY
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5633
Mailing Address - Country:US
Mailing Address - Phone:616-328-1919
Mailing Address - Fax:
Practice Address - Street 1:900 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4520
Practice Address - Country:US
Practice Address - Phone:701-530-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR45225367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered