Provider Demographics
NPI:1194703462
Name:WOLD, DEBRA JAN (CRNA)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JAN
Last Name:WOLD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:JAN
Other - Last Name:SHAWVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:392 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3333
Mailing Address - Country:US
Mailing Address - Phone:707-459-4757
Mailing Address - Fax:
Practice Address - Street 1:1 MADRONE ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4225
Practice Address - Country:US
Practice Address - Phone:707-456-3171
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA701367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered