Provider Demographics
NPI:1326342411
Name:SANAZARO, DEBORAH LYNN (RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:SANAZARO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 HIGHTOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3362
Mailing Address - Country:US
Mailing Address - Phone:314-843-2110
Mailing Address - Fax:314-842-9215
Practice Address - Street 1:3525 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1007
Practice Address - Country:US
Practice Address - Phone:314-977-8929
Practice Address - Fax:314-977-8840
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO058156282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital