Provider Demographics
NPI:1417921503
Name:MCLANAHAN, DEBORAH L (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:MCLANAHAN
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 1:1580 LAKEWOOD RD
Mailing Address - Street 2:SUITE 16B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-3287
Mailing Address - Country:US
Mailing Address - Phone:800-730-5347
Mailing Address - Fax:
Practice Address - Street 1:1580 LAKEWOOD RD
Practice Address - Street 2:SUITE 16B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-3287
Practice Address - Country:US
Practice Address - Phone:800-730-5347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN092316363LF0000X
PANN092316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070793YHM7OtherPTAN
NJ0005878Medicaid
070793YHM6OtherPTAN
NJP91958Medicare UPIN