Provider Demographics
NPI:1427001130
Name:SCATTARELLI, DEBORAH A (CNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:SCATTARELLI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 6TH AVE N
Mailing Address - Street 2:ST. CLOUD HOSPITAL
Mailing Address - City:ST. CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1901
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-656-7009
Practice Address - Street 1:1586 COUNTY ROAD 134
Practice Address - Street 2:ST. CLOUD HOSPITAL
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-251-0726
Practice Address - Fax:320-229-5188
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0936569363LA2200X
MNR-093656-9363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN344024900Medicaid
MN500000191Medicare ID - Type Unspecified
MN344024900Medicaid