Provider Demographics
NPI:1376629709
Name:PETRISCAK-ONKEN, DEBORAH ANN (DNP, GNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:PETRISCAK-ONKEN
Suffix:
Gender:F
Credentials:DNP, GNP-BC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:ONKEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, GNP-BC
Mailing Address - Street 1:26853 COLD SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-5307
Mailing Address - Country:US
Mailing Address - Phone:818-300-5404
Mailing Address - Fax:805-777-1132
Practice Address - Street 1:13652 CANTARA ST
Practice Address - Street 2:BALBOA PLAZA
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-832-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16717363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology