Provider Demographics
NPI:1841529047
Name:DELUCA, DONALD P (CRNA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:DELUCA
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 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5452
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5452
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-330494-L163W00000X
PA084384367500000X
AZ223567367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2141989OtherHIGHMARK
PA3759078000OtherIBC
PA9569435OtherAETNA
PA50090192OtherCAPITAL ADVANTAGE
PA1586736OtherGATEWAY
PA1027802620001Medicaid
PA2141989OtherFIRST PRIORITY
PA131519OtherGEISINGER
PA12027205OtherCAQH
PA50090192OtherCAPITAL ADVANTAGE
PA2141989OtherHIGHMARK