Provider Demographics
NPI:1790094787
Name:REDUS, DEBORAH ANN (CSA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:REDUS
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 STONESTREET RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-6808
Mailing Address - Country:US
Mailing Address - Phone:502-933-1100
Mailing Address - Fax:502-933-1153
Practice Address - Street 1:9702 STONESTREET RD
Practice Address - Street 2:SUITE 304
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-6808
Practice Address - Country:US
Practice Address - Phone:502-933-1100
Practice Address - Fax:502-933-1153
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA217246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant