Provider Demographics
NPI:1104854769
Name:VINES-LOWE, DEBORAH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:VINES-LOWE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650802
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0802
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:13601 PRESTON RD
Practice Address - Street 2:SUITE 1000W
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4911
Practice Address - Country:US
Practice Address - Phone:972-715-5007
Practice Address - Fax:972-715-5682
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX523089367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX430030285OtherRAILROAD MEDICARE
TXP01000315OtherRR MEDICARE
TX0796757Medicaid
TX88141UOtherBCBS
TX126120808Medicaid
TX8723UAOtherBCBS
TX88141UOtherBCBS
TX430030285OtherRAILROAD MEDICARE
TX0796757Medicaid