=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356437032
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA LYNN MCRAVEN CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 06/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 FLOYD AVE
-----------------------------------------------------
City | ROCKY MOUNT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24151-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-489-6353
-----------------------------------------------------
Fax | 540-484-8552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213 S JEFFERSON ST STE 1006
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24011-1713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-224-5705
-----------------------------------------------------
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 | NUR-APRN-LIC-127290
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 209004893
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 0024189984
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | APN.0100026-CRNA
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------