Provider Demographics
NPI:1982687091
Name:HILBURN, DEBORAH LOU (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LOU
Last Name:HILBURN
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 3927
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3927
Mailing Address - Country:US
Mailing Address - Phone:423-282-6512
Mailing Address - Fax:
Practice Address - Street 1:157 S PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1936
Practice Address - Country:US
Practice Address - Phone:864-560-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC293367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0407Medicaid
SCAN0407Medicaid
VAVV1148AMedicare PIN