Provider Demographics
NPI:1770576704
Name:SIDERS, DEBORAH LYNNE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNNE
Last Name:SIDERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:LYNNE
Other - Last Name:SIDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:629 FAIRWAY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-8394
Mailing Address - Country:US
Mailing Address - Phone:336-877-3376
Mailing Address - Fax:
Practice Address - Street 1:200 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9244
Practice Address - Country:US
Practice Address - Phone:336-846-7101
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC193584367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered