Provider Demographics
NPI:1649331489
Name:WASHAM, DEBORAH C (RN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:C
Last Name:WASHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12435 WORNALL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1119
Mailing Address - Country:US
Mailing Address - Phone:816-943-6465
Mailing Address - Fax:816-943-1235
Practice Address - Street 1:12435 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1119
Practice Address - Country:US
Practice Address - Phone:816-943-6465
Practice Address - Fax:816-943-1235
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO067295174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21640012OtherBLUECROSS BLUE SHIELD
0930730001Medicare ID - Type Unspecified