Provider Demographics
NPI:1225063225
Name:STARR, DEBORAH JOAN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JOAN
Last Name:STARR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BATA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1420
Mailing Address - Country:US
Mailing Address - Phone:410-575-6611
Mailing Address - Fax:410-575-6018
Practice Address - Street 1:103 BATA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1420
Practice Address - Country:US
Practice Address - Phone:410-575-6611
Practice Address - Fax:410-575-6018
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR076792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD130651100Medicaid
MDR13016Medicare UPIN
MDKR67J634Medicare ID - Type Unspecified