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NPI Code Detail

MEDICARE: DEBORAH DEENA AGNP

MEDICARE: DEBORAH DEENA AGNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner132161NC

General Provider Information

NPI Number : 1548784853
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH DEENA AGNP
Provider Business Mailing Address
First Line : 900 MAPLE RIDGE RD
Second Line :
City : GREENVILLE
State : NC
Zip : 27858-9585
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1106 KINGOLD BLVD
Second Line :
City : SNOW HILL
State : NC
Zip : 28580-1619
Country : US
Telephone Number : 252-747-2921
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2017
Last Update Date : 02/01/2023

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