Healthcare Provider Details

I. General information

NPI: 1740431535
Provider Name (Legal Business Name): DEBRA J. STOTTS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FRESNO & R STREET
FRESNO CA
93721-1365
US

IV. Provider business mailing address

PO BOX 1843
BAKERSFIELD CA
93303-1843
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-6000
  • Fax:
Mailing address:
  • Phone: 661-335-7755
  • Fax: 661-335-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA3694
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: