Provider Demographics
NPI:1063437713
Name:RICHARDSON, DEBORAH JEANNE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEANNE
Last Name:RICHARDSON
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 1:7604 TIMBERLY CT
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2522
Mailing Address - Country:US
Mailing Address - Phone:703-442-8599
Mailing Address - Fax:703-442-8833
Practice Address - Street 1:1300 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3935
Practice Address - Country:US
Practice Address - Phone:703-790-5454
Practice Address - Fax:703-790-9184
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024045604367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered