Provider Demographics
NPI:1861403107
Name:DEBARTO, JEANNE M (CRNA)
Entity type:Individual
Prefix:MISS
First Name:JEANNE
Middle Name:M
Last Name:DEBARTO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:DEBARTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:111 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6127
Mailing Address - Country:US
Mailing Address - Phone:208-336-0895
Mailing Address - Fax:208-338-1796
Practice Address - Street 1:111 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6127
Practice Address - Country:US
Practice Address - Phone:208-336-0895
Practice Address - Fax:208-338-1796
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA500367500000X
WAAP60268686367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806142300Medicaid