Provider Demographics
NPI:1114001773
Name:STUBBLEFIELD, DEBORAH ANN (RCP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-1309
Mailing Address - Country:US
Mailing Address - Phone:505-894-6640
Mailing Address - Fax:505-894-9482
Practice Address - Street 1:612 N DATE ST
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1742
Practice Address - Country:US
Practice Address - Phone:505-894-6640
Practice Address - Fax:505-894-9482
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM210227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00TB63OtherBCBS
NM29126771Medicaid
NM6107460001Medicare NSC