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General NPI Number Information
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NPI Number | 1063855237
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Entity Type | Individual
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Provider Name | DEBORAH L KHALIFE PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 824 MCALPINE ST
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City | AVOCA
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State | PA
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Zip | 18641
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Country | US
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Telephone | 570-457-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 115 JASON DR
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City | WILKES BARRE
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State | PA
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Zip | 18702-2726
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Country | US
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Telephone | 570-825-5673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA-001376-L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA000106L
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License Number State | PA
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