Provider Demographics
NPI:1801103452
Name:AUCKERMAN, DUSTYN W (CRNA)
Entity type:Individual
Prefix:
First Name:DUSTYN
Middle Name:W
Last Name:AUCKERMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E PALMER RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2281
Mailing Address - Country:US
Mailing Address - Phone:937-592-4015
Mailing Address - Fax:937-292-7148
Practice Address - Street 1:205 E PALMER RD
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311
Practice Address - Country:US
Practice Address - Phone:937-592-4015
Practice Address - Fax:937-292-7148
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN301597367500000X
OHAPRN.CRNA.11865367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3123453Medicaid