Provider Demographics
NPI:1649299298
Name:DYKES, ALANE LEE (CRNA)
Entity type:Individual
Prefix:MS
First Name:ALANE
Middle Name:LEE
Last Name:DYKES
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 1:100 THUNDERBIRD DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5150
Mailing Address - Country:US
Mailing Address - Phone:928-204-2303
Mailing Address - Fax:
Practice Address - Street 1:100 THUNDERBIRD DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5150
Practice Address - Country:US
Practice Address - Phone:928-204-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN108884367500000X
AZCRNA0112367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS31028Medicare UPIN
AZZ113389Medicare PIN
FL000G2089Medicare ID - Type UnspecifiedPROVIDER NUMBER