Provider Demographics
NPI:1003058454
Name:DEAFENBAUGH, LUANN (NP)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:DEAFENBAUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 PROVIDENT DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3291
Mailing Address - Country:US
Mailing Address - Phone:574-372-3800
Mailing Address - Fax:574-372-5823
Practice Address - Street 1:1520 PROVIDENT DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3291
Practice Address - Country:US
Practice Address - Phone:574-372-3800
Practice Address - Fax:574-372-5823
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28067608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200939080Medicare PIN
IN453220DDDMedicare PIN
IN262490HHMedicare PIN