=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114902277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH WHITMIRE PITTILLO FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2005
-----------------------------------------------------
Last Update Date | 04/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2695 HENDERSONVILLE RD STE 200
-----------------------------------------------------
City | ARDEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28704-8576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-684-6035
-----------------------------------------------------
Fax | 828-654-8152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 27877
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84127-0877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-694-8350
-----------------------------------------------------
Fax | 828-694-7654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 201649
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------