Provider Demographics
NPI:1881696441
Name:DEARBORN, JUDITH ELIZABETH (CRNA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELIZABETH
Last Name:DEARBORN
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:PO BOX 140427
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-0427
Mailing Address - Country:US
Mailing Address - Phone:907-338-2815
Mailing Address - Fax:
Practice Address - Street 1:2801 DEBARR RD
Practice Address - Street 2:ALASKA REGIONAL HOSPITAL
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2932
Practice Address - Country:US
Practice Address - Phone:907-276-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0019794367500000X
MEAA083008367500000X
AKCRNA AA 110367500000X
NH025110-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRNA0013Medicaid
40Y003095NH02OtherANTHEM
277245OtherHARVARD PILGRIM
AKRNA0013Medicaid
AK151063Medicare PIN
MEME1185Medicare PIN
VTVN2188Medicare PIN