Provider Demographics
NPI:1881431369
Name:DEAN, DEANNA S (BSN, RN, CNOR, RNASC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:S
Last Name:DEAN
Suffix:
Gender:F
Credentials:BSN, RN, CNOR, RNASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7993
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546
Mailing Address - Country:US
Mailing Address - Phone:760-914-2563
Mailing Address - Fax:
Practice Address - Street 1:85 SIERRA PARK ROAD
Practice Address - Street 2:PO BOX 660
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546
Practice Address - Country:US
Practice Address - Phone:760-934-3311
Practice Address - Fax:760-934-7285
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95051481163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant