Provider Demographics
NPI:1548381080
Name:BRASIC, DEBORAH MAGNAN (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MAGNAN
Last Name:BRASIC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:BRASIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1988 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6647
Mailing Address - Country:US
Mailing Address - Phone:910-251-1839
Mailing Address - Fax:910-251-8286
Practice Address - Street 1:1988 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6647
Practice Address - Country:US
Practice Address - Phone:910-251-1839
Practice Address - Fax:910-251-8286
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201491OtherMEDICAL LICENSE
NC201491OtherMEDICAL LICENSE