Provider Demographics
NPI:1194818492
Name:MANCE, DEBORAH (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MANCE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 OREGON TRL
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-5319
Mailing Address - Country:US
Mailing Address - Phone:845-744-2903
Mailing Address - Fax:845-744-8262
Practice Address - Street 1:532 BLOOMING GROVE TPKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7846
Practice Address - Country:US
Practice Address - Phone:845-562-7800
Practice Address - Fax:845-562-0213
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily