Provider Demographics
NPI:1558717462
Name:WANTEK, DEBORAH (RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WANTEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-2266
Mailing Address - Country:US
Mailing Address - Phone:860-832-6214
Mailing Address - Fax:860-827-4947
Practice Address - Street 1:2150 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-2266
Practice Address - Country:US
Practice Address - Phone:860-832-6214
Practice Address - Fax:860-827-4947
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE51120163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse