Provider Demographics
NPI:1730146408
Name:LUMBLEY, DEBRA SUE (CRNA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:LUMBLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:RIEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1340 WOLF CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GOREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62939-2031
Mailing Address - Country:US
Mailing Address - Phone:870-882-2239
Mailing Address - Fax:
Practice Address - Street 1:1100 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2029
Practice Address - Country:US
Practice Address - Phone:573-803-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021283367500000X
ARC01387367500000X
MO2023047203367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214881OtherMULTISPECIALTY GROUP PTAN
AR154308701Medicaid