Provider Demographics
NPI:1104872860
Name:DUNHAM, DEBRA (CRNA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:DUNHAM
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 1:1044 SW 44TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3609
Mailing Address - Country:US
Mailing Address - Phone:405-631-4263
Mailing Address - Fax:405-631-4820
Practice Address - Street 1:1044 SW 44TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3609
Practice Address - Country:US
Practice Address - Phone:405-631-4263
Practice Address - Fax:405-631-4820
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0053522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS53016Medicare UPIN
OK245600704Medicare PIN