Provider Demographics
NPI:1124014188
Name:DEAVOURS, DEBORAH R (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:R
Last Name:DEAVOURS
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 1:1201 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3410
Mailing Address - Country:US
Mailing Address - Phone:205-930-7246
Mailing Address - Fax:205-930-7256
Practice Address - Street 1:1201 11TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3410
Practice Address - Country:US
Practice Address - Phone:205-930-7246
Practice Address - Fax:205-930-7256
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-027383367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1124014188OtherTRICARE STANDARD
AL510-03661OtherBC BS OF AL
AL051557592Medicaid
ALP00312332OtherRAILROAD MEDICARE
ALP00312332OtherRAILROAD MEDICARE
ALR77115Medicare UPIN