Provider Demographics
NPI:1356437032
Name:MCRAVEN, DEBRA LYNN (CRNA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:MCRAVEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5705
Mailing Address - Fax:
Practice Address - Street 1:180 FLOYD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1318
Practice Address - Country:US
Practice Address - Phone:540-489-6353
Practice Address - Fax:540-484-8552
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-127290367500000X
IL209004893367500000X
VA0024189984367500000X
COAPN.0100026-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01267090OtherRR MEDICARE
CO21772762Medicaid
WY136647500Medicaid
CO326265YTMFMedicare PIN