Provider Demographics
NPI:1710900709
Name:LATHAM, DEBORAH B (RN,CRNA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:B
Last Name:LATHAM
Suffix:
Gender:F
Credentials:RN,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 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP106901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP008710407OtherRAILROAD
TX89626UOtherBCBS
TX109846910Medicaid
TX88805UOtherBCBSTX
TX315278703Medicaid
TX109846913Medicaid
TX1098469-05Medicaid
TX8729UHOtherBCBS TX
TX109846912OtherMEDICAID CSHCN
TX8335UGOtherBCBS TX
TX272237YK6UMedicare PIN
TX366028YK6UMedicare PIN
TX8335UGOtherBCBS TX
TX8729UHOtherBCBS TX
TX109846910Medicaid
TX109846913Medicaid