Provider Demographics
NPI:1881707065
Name:ATHEY, DEAN KEITH (CRNA)
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:KEITH
Last Name:ATHEY
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 1:3471 E 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601
Mailing Address - Country:US
Mailing Address - Phone:402-564-5388
Mailing Address - Fax:
Practice Address - Street 1:4600 38TH ST
Practice Address - Street 2:COLUMBUS COMMUNITY HOSPITAL
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
Practice Address - Country:US
Practice Address - Phone:402-564-7118
Practice Address - Fax:402-562-3376
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100376367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE277099OtherCOVENTRY
NE4026OtherMIDLANDS
NE279959Medicare ID - Type UnspecifiedCCH MEDICARE PROV #
NER80743Medicare UPIN