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General NPI Number Information
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NPI Number | 1831134394
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Entity Type | Individual
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Provider Name | DEBORAH A AULTMAN PAC
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Gender | Female
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 620 W MAIN ST PO 818
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City | STANTON
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State | MI
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Zip | 48888-9239
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Country | US
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Telephone | 989-427-3331
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Fax | 989-427-3037
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Provider Business Mailing Address
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Address Line | 620 W MAIN ST PO BOX 818
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City | STANTON
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State | MI
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Zip | 48888-9239
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Country | US
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Telephone | 989-831-7723
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Fax | 989-831-8303
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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 | 5601003901
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License Number State | MI
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