Provider Demographics
NPI:1164415261
Name:SEBASTIAN, DEBBIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:A
Last Name:SEBASTIAN
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 12749
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41012-0749
Mailing Address - Country:US
Mailing Address - Phone:513-523-0022
Mailing Address - Fax:513-523-0022
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:513-523-0022
Practice Address - Fax:513-523-0022
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN223077174400000X
KY1108168163W00000X
KY045245367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000318542OtherANTHEM BCBS
OHP00098202OtherRAILROAD MEDICARE
OH0224948Medicaid
000000375727OtherANTHEM
KY74010364Medicaid
OHSE8232261Medicare ID - Type Unspecified
000000375727OtherANTHEM
OH000000318542OtherANTHEM BCBS
P00266737Medicare PIN