NPI Record of ZAKLINA DENDOOVEN CRNA NPI 1003873076

Nurse Anesthetist, Certified Registered in Detroit, MI

Complete NPI Record


Field Name Value Definition
NPI1003873076National Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code1Entity type code (type of health care provider assigned an NPI).
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Last Name Legal NameDENDOOVENProvider last name.
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First NameZAKLINAProvider first name.
The first name of the provider, if the provider is an individual.
Provider Credential TextCRNAProvider credential text.
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing AddressDEPT 203401Provider first line mailing address.
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing AddressPO BOX 67000Provider second line mailing address.
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City NameDETROITProvider mailing address city name.
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameMIProvider mailing address State name.
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code482670001Provider mailing address postal code.
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USProvider mailing address country code.
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number9524429770Provider mailing address telephone number.
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number9524423630Provider mailing address fax number.
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address6071 W OUTER DRProvider first line location address.
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameDETROITProvider location address city name.
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMIProvider location address State code.
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code482352624Provider location address postal code.
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USProvider location address country code.
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number9524429770Provider location address telephone number.
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date4/26/2006Provider enumeration date.
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date7/8/2007Last update date.
The date that a record was last updated or changed.
Provider Gender CodeFProvider gender code.
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1367500000XProvider taxonomy code.
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 14704217495Provider license number.
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1MIProvider license number State code.
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Other Provider Identifier 1N24360172Other provider identifier.
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 104Other provider identifier type code.
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1MI
Other Provider Identifier 2ZD217495Other provider identifier.
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 201Other provider identifier type code.
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2MI
Other Provider Identifier Issuer 2BLUE CROSS OF MI
Is Sole ProprietorXIs Sole Proprietor.
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No