Provider Demographics
NPI:1346533056
Name:MARTIN, DEBORAH A (CRNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:STALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:814-827-8400
Mailing Address - Fax:814-827-8405
Practice Address - Street 1:120 S MARTIN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1850
Practice Address - Country:US
Practice Address - Phone:814-827-8400
Practice Address - Fax:814-827-8405
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102622862Medicaid
PA224931RN0Medicare Oscar/Certification