Healthcare Provider Details

I. General information

NPI: 1124044573
Provider Name (Legal Business Name): DEBORAH PRICE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N 10TH ST
FORT DODGE IA
50501-3915
US

IV. Provider business mailing address

126 N 10TH ST
FORT DODGE IA
50501-3915
US

V. Phone/Fax

Practice location:
  • Phone: 515-576-6500
  • Fax:
Mailing address:
  • Phone: 515-576-6500
  • Fax: 515-576-1951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberG143871
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: