Healthcare Provider Details

I. General information

NPI: 1982705901
Provider Name (Legal Business Name): DEBORAH IRENE SCULLON CRNA,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1545
US

IV. Provider business mailing address

866 OLD QUARRY RD S
LARKSPUR CA
94939-2218
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-2069
  • Fax:
Mailing address:
  • Phone: 415-531-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number407480
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: