Provider Demographics
NPI:1447203328
Name:MAURO, DEBORAH J (CRNA)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:J
Last Name:MAURO
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 1:38021 BAY ST NE
Mailing Address - Street 2:
Mailing Address - City:HANSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98340-7736
Mailing Address - Country:US
Mailing Address - Phone:208-596-3535
Mailing Address - Fax:
Practice Address - Street 1:414 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2332
Practice Address - Country:US
Practice Address - Phone:253-260-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN0083064163W00000X
WAAP30006495367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9650623Medicaid
WA9650623Medicaid