Provider Demographics
NPI:1225394992
Name:BASS, DEBORAH SUE (CSA)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:SUE
Last Name:BASS
Suffix:
Gender:F
Credentials:CSA
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Mailing Address - Street 1:2802 GREEN MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5250
Mailing Address - Country:US
Mailing Address - Phone:281-416-9972
Mailing Address - Fax:
Practice Address - Street 1:2802 GREEN MEADOW CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-5250
Practice Address - Country:US
Practice Address - Phone:281-416-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-07
Last Update Date:2012-04-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical