Provider Demographics
NPI:1285771634
Name:DEHNER, BRYAN KEITH (NURSE ANESTHETIST)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:KEITH
Last Name:DEHNER
Suffix:
Gender:M
Credentials:NURSE ANESTHETIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 TRAIL CREST LN
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-4999
Mailing Address - Country:US
Mailing Address - Phone:619-384-9013
Mailing Address - Fax:
Practice Address - Street 1:2607 SAINT ANNE WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-3895
Practice Address - Country:US
Practice Address - Phone:619-384-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA667489163W00000X
WI178376-030367500000X
IL209.008888367500000X
OHAPRN.CRNA.019935367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse