Provider Demographics
NPI:1336193168
Name:DEBELLIS, MICHELLE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:DEBELLIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4006 LONDON BRIDGE RD
Mailing Address - Street 2:LOT 7
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-9703
Mailing Address - Country:US
Mailing Address - Phone:512-689-5787
Mailing Address - Fax:
Practice Address - Street 1:10120 S EASTERN AVE
Practice Address - Street 2:STE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3951
Practice Address - Country:US
Practice Address - Phone:702-487-6880
Practice Address - Fax:702-473-5455
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX696020367500000X
NVRN21576163W00000X
NVCRNA000333367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse