=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003976903
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH SUE DAY CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S 9TH ST
-----------------------------------------------------
City | KINGFISHER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73750-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-375-3141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 897
-----------------------------------------------------
City | KINGFISHER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73750-0897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-538-9051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | R0030394
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------