Provider Demographics
NPI:1477706224
Name:DETCHON, NICHOLAS ROSS (CRNA)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ROSS
Last Name:DETCHON
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:3333 BURNET AVE., ML 2001
Mailing Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL, DEPT. OF ANESTHESIA
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-4408
Mailing Address - Fax:513-636-7337
Practice Address - Street 1:3333 BURNET AVE., ML 2001
Practice Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL, DEPT. OF ANESTHESIA
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4408
Practice Address - Fax:513-636-7337
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
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Provider Licenses
StateLicense IDTaxonomies
OHRN296867367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered