Provider Demographics
NPI:1225097835
Name:NEEDLE, DEBORAH A (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:NEEDLE
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 1:1557 SAINT MARGARETS RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5554
Mailing Address - Country:US
Mailing Address - Phone:443-838-5914
Mailing Address - Fax:
Practice Address - Street 1:1321 GENERALS HWY STE 101B
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2060
Practice Address - Country:US
Practice Address - Phone:443-837-6314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR146447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD208256OtherJHHC PROVIDER NUMBER
MD7605-0090OtherCAREFIRST BLUECHOICE
MDZEZJOtherMEDICARE GROUP
MD412394800Medicaid
MD641281-02OtherCAREFIRST MD RENDERING
MD208256OtherJHHC PROVIDER NUMBER
MD412394800Medicaid