Provider Demographics
NPI:1437601085
Name:DEBIASI, MARCUS OTAVIO GUIMARAES (CRNP)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:OTAVIO GUIMARAES
Last Name:DEBIASI
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:MARCUS
Other - Middle Name:OTAVIO
Other - Last Name:GUIMARAES DEBIASI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:1714 9TH AVE S STE 300
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3606
Practice Address - Country:US
Practice Address - Phone:205-934-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-120823363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health