Provider Demographics
NPI:1437130465
Name:CLISE, DEBRA (CRNA)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:CLISE
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 1:804 AMBER TREE CT APT 302
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5206
Mailing Address - Country:US
Mailing Address - Phone:301-948-3077
Mailing Address - Fax:301-948-3077
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0003
Practice Address - Country:US
Practice Address - Phone:202-782-7748
Practice Address - Fax:202-782-7748
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR123183367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered