Provider Demographics
NPI:1356663835
Name:PAULK, DEBORAH STARR (LPN)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:STARR
Last Name:PAULK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ARDEN AVE
Mailing Address - Street 2:LOWER
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3312
Mailing Address - Country:US
Mailing Address - Phone:716-602-3874
Mailing Address - Fax:
Practice Address - Street 1:20 ARDEN AVE
Practice Address - Street 2:LOWER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3312
Practice Address - Country:US
Practice Address - Phone:716-602-3874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300246-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse