Individual
DEANA MARIE FANTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8000 E MAPLEWOOD AVE STE 200, GREENWOOD VILLAGE, CO 80111-4727
(303) 438-3999
(720) 439-9500
Mailing address
PO BOX 840862, DALLAS, TX 75284-0862
(303) 377-7638
(303) 780-0787
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
127479
CO
367500000X
Certified Registered Nurse Anesthetist
Primary
APN.0100067-CRNA
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127479
COLORADO LICENSE
CO
01
—
RN1014827
STATE LICENSE
DC
Enumeration date
02/08/2011
Last updated
04/30/2026
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