=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558358424
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH PETERMAN NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2005
-----------------------------------------------------
Last Update Date | 06/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34434 KING STREET ROW SUITE 4
-----------------------------------------------------
City | LEWES
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19958-4787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-360-0142
-----------------------------------------------------
Fax | 302-360-0145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4923 OGLETOWN STANTON RD SUITE 200
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19713-2081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-225-0451
-----------------------------------------------------
Fax | 302-225-0472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | LB0000139
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------