Basic Information
Provider Information | |||||||||
NPI: | 1689196198 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | DHN ANESTHESIA PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3884 S 39TH DR | ||||||||
Address2: |   | ||||||||
City: | YUMA | ||||||||
State: | AZ | ||||||||
PostalCode: | 853657957 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9283179100 | ||||||||
FaxNumber: | 9283179300 | ||||||||
Practice Location | |||||||||
Address1: | 1030 W 24TH ST | ||||||||
Address2: |   | ||||||||
City: | YUMA | ||||||||
State: | AZ | ||||||||
PostalCode: | 853648345 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9283179100 | ||||||||
FaxNumber: | 9283179300 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2017 | ||||||||
LastUpdateDate: | 07/17/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | THANT | ||||||||
AuthorizedOfficialFirstName: | DIANA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
AuthorizedOfficialTelephone: | 9289199100 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 36152 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.