Healthcare Provider Details

I. General information

NPI: 1063097061
Provider Name (Legal Business Name): DEBORAH MERCY PERSYN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7935 ECHO WIND ST
SAN ANTONIO TX
78250-4710
US

IV. Provider business mailing address

7935 ECHO WIND ST
SAN ANTONIO TX
78250-4710
US

V. Phone/Fax

Practice location:
  • Phone: 210-379-8494
  • Fax:
Mailing address:
  • Phone: 210-379-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-301024
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number901128
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: