Provider Demographics
NPI:1376593558
Name:SPOSATO, DEBORAH INEZ (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:INEZ
Last Name:SPOSATO
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 701146
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-1146
Mailing Address - Country:US
Mailing Address - Phone:918-550-9537
Mailing Address - Fax:
Practice Address - Street 1:1922 E 74TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7489
Practice Address - Country:US
Practice Address - Phone:918-550-9537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC143545367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2614939JMedicare PIN
NC2614939GMedicare ID - Type Unspecified