Healthcare Provider Details

I. General information

NPI: 1497753586
Provider Name (Legal Business Name): DEBORAH J PLOTKIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 N WINDSONG DR
PRESCOTT VALLEY AZ
86314
US

IV. Provider business mailing address

PO BOX 26568
PRESCOTT VALLEY AZ
86312-6568
US

V. Phone/Fax

Practice location:
  • Phone: 928-772-2582
  • Fax: 928-772-2383
Mailing address:
  • Phone: 928-778-1251
  • Fax: 928-778-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN211833
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number156655
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP10884
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: