Provider Demographics
NPI:1538331624
Name:FUENTES, DEBORAH A (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:FUENTES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 1081
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-1945
Mailing Address - Fax:212-305-0178
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1081
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-1945
Practice Address - Fax:212-305-0178
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily