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General NPI Number Information
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NPI Number | 1336351089
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Entity Type | Individual
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Provider Name | DEBORAH ANN BARESIC WHNP
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7910 W JEFFERSON BLVD STE 301
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City | FORT WAYNE
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State | IN
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Zip | 46804-4159
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Country | US
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Telephone | 260-432-6250
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Fax | 260-432-6077
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Provider Business Mailing Address
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Address Line | 6705 WOODCREST DR
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City | FORT WAYNE
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State | IN
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Zip | 46815-5568
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Country | US
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Telephone | 260-485-6428
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Fax | 260-436-7220
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 71000624A
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License Number State | IN
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