Provider Demographics
NPI:1407333164
Name:DEBUSSY, MARK ROBERT (APRN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ROBERT
Last Name:DEBUSSY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 GOLDFINCH TURN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4112
Mailing Address - Country:US
Mailing Address - Phone:302-379-0899
Mailing Address - Fax:
Practice Address - Street 1:256 CHAPMAN RD STE 105-1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5499
Practice Address - Country:US
Practice Address - Phone:302-379-0899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002383363LP0808X
DEL8-0000176363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health