Provider Demographics
NPI:1174572341
Name:DEHAAN, DIRK (CRNA)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:
Last Name:DEHAAN
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 1:4444 CORONA
Mailing Address - Street 2:STE 232
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-858-8525
Mailing Address - Fax:361-858-8809
Practice Address - Street 1:5950 SARATOGA BLVD
Practice Address - Street 2:CHRISTUS SPOHN SOUTH
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413
Practice Address - Country:US
Practice Address - Phone:361-985-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX635914367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82560QOtherBCBS
TX86247UOtherBCBSTX
TX85273UOtherBCBS
TX8G7982Medicare PIN
TX82560QOtherBCBS
TX86247UOtherBCBSTX