Healthcare Provider Details

I. General information

NPI: 1902005630
Provider Name (Legal Business Name): DEBORAH SCHLODER DEMURO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH ANNE SCHLODER CRNP

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 UNIVERSITY DR
STATE COLLEGE PA
16801-6626
US

IV. Provider business mailing address

905 UNIVERSITY DR
STATE COLLEGE PA
16801-6626
US

V. Phone/Fax

Practice location:
  • Phone: 814-238-8418
  • Fax: 814-234-2888
Mailing address:
  • Phone: 814-238-8418
  • Fax: 814-234-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberUP000863G
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberUP000863G
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: