Healthcare Provider Details

I. General information

NPI: 1568685394
Provider Name (Legal Business Name): DEBORAH LYNNE MOTTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SHANNON LANE
ASSONET MA
02702
US

IV. Provider business mailing address

10 SHANNON LANE
ASSONET MA
02702
US

V. Phone/Fax

Practice location:
  • Phone: 508-644-5694
  • Fax:
Mailing address:
  • Phone: 508-644-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number205470
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: