Provider Demographics
NPI:1114534187
Name:DEBORAH DEMBO APRN, LLC
Entity Type:Organization
Organization Name:DEBORAH DEMBO APRN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMBO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-391-8659
Mailing Address - Street 1:4 STRAITS RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06412-1330
Mailing Address - Country:US
Mailing Address - Phone:860-391-8659
Mailing Address - Fax:
Practice Address - Street 1:4 STRAITS RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:CT
Practice Address - Zip Code:06412-1330
Practice Address - Country:US
Practice Address - Phone:860-391-8659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty