Healthcare Provider Details

I. General information

NPI: 1124014188
Provider Name (Legal Business Name): DEBORAH R DEAVOURS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 11TH AVE S
BIRMINGHAM AL
35205-3410
US

IV. Provider business mailing address

1201 11TH AVE S
BIRMINGHAM AL
35205-3410
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-7246
  • Fax: 205-930-7256
Mailing address:
  • Phone: 205-930-7246
  • Fax: 205-930-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-027383
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: