Provider Demographics
NPI:1407016777
Name:DEIERLEIN, DEBORAH ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:DEIERLEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 BELLE MEAD RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733
Mailing Address - Country:US
Mailing Address - Phone:631-444-4274
Mailing Address - Fax:631-444-4276
Practice Address - Street 1:181 BELLE MEAD RD
Practice Address - Street 2:SUITE 6
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-444-4274
Practice Address - Fax:631-444-4276
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301059363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health