Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35088823 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 35088823 | OH |
NPI | 1003007741 |
---|---|
Provider Name | Dr. Krisanna L Deppen |
First Address | Dublin, OH 43016-4259 |
Second Address | Grove City, OH 43123-3993 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2912352 | (05) | OH |