Provider Demographics
NPI:1225245905
Name:MACHAIN, DEBRA DAWN (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DAWN
Last Name:MACHAIN
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 1:623 EVERITT MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2014
Mailing Address - Country:US
Mailing Address - Phone:530-925-2797
Mailing Address - Fax:
Practice Address - Street 1:623 EVERITT MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2014
Practice Address - Country:US
Practice Address - Phone:530-925-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1756367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8146135Medicaid
CAZZZ276432Medicare ID - Type Unspecified