Provider Demographics
NPI:1477553048
Name:ALLENSPACH, DEBRA ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:ALLENSPACH
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 346
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0346
Mailing Address - Country:US
Mailing Address - Phone:252-548-2208
Mailing Address - Fax:
Practice Address - Street 1:211 VIRGINIA RD
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9668
Practice Address - Country:US
Practice Address - Phone:252-482-6188
Practice Address - Fax:423-283-0549
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000010697367500000X
NC115052367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3631825Medicaid
TN3631825Medicare ID - Type Unspecified
TNOTH000Medicare UPIN