Provider Demographics
NPI:1356384994
Name:SMART, DEBORAH (CRNA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SMART
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 1:457 ROCK RUN RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-8819
Mailing Address - Country:US
Mailing Address - Phone:610-469-6294
Mailing Address - Fax:
Practice Address - Street 1:12TH & WALNUT STREET
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604
Practice Address - Country:US
Practice Address - Phone:610-378-2823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN564767367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003156493AMedicaid
FL013626900Medicaid
GA003156493AMedicaid
FLHZ431ZMedicare PIN