Provider Demographics
NPI:1669280947
Name:ALTENBERND, DEANNA L (RN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:ALTENBERND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4536
Mailing Address - Country:US
Mailing Address - Phone:618-462-1585
Mailing Address - Fax:
Practice Address - Street 1:1665 WILSON AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-4536
Practice Address - Country:US
Practice Address - Phone:618-462-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113913163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health