Provider Demographics
NPI:1043281819
Name:DOHRMANN, JACQUALINE L (CRNA)
Entity type:Individual
Prefix:
First Name:JACQUALINE
Middle Name:L
Last Name:DOHRMANN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25674 DEWEY RD
Mailing Address - Street 2:
Mailing Address - City:EDGEMONT
Mailing Address - State:SD
Mailing Address - Zip Code:57735-7004
Mailing Address - Country:US
Mailing Address - Phone:605-749-2308
Mailing Address - Fax:
Practice Address - Street 1:25674 DEWEY RD
Practice Address - Street 2:
Practice Address - City:EDGEMONT
Practice Address - State:SD
Practice Address - Zip Code:57735-7004
Practice Address - Country:US
Practice Address - Phone:605-749-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX560951367500000X
SDR032057-0492367500000X
WY20192.259367500000X
NE100820367500000X
ARC01057367500000X
IDRNA-617367500000X
NMR27793367500000X
KS23817367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84005UOtherBCBS
TX84005UOtherBCBS
SDR71367Medicare UPIN