Healthcare Provider Details

I. General information

NPI: 1245221456
Provider Name (Legal Business Name): DEBORAH MIKA-DAY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH DAY CRNA

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 DOUGHERTY FERRY RD
SAINT LOUIS MO
63122-3313
US

IV. Provider business mailing address

13515 BARRETT PARKWAY DR SUITE 170
BALLWIN MO
63021-5870
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-5850
  • Fax:
Mailing address:
  • Phone: 314-775-2816
  • Fax: 314-775-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number076164
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: