Provider Demographics
NPI:1821091109
Name:SALLEY, DEBORAH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:SALLEY
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 1886
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-1886
Mailing Address - Country:US
Mailing Address - Phone:864-716-7907
Mailing Address - Fax:864-225-9035
Practice Address - Street 1:107 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2052
Practice Address - Country:US
Practice Address - Phone:864-716-7907
Practice Address - Fax:864-225-9035
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR51727367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0916Medicaid
SCAN0916Medicaid