Provider Demographics
NPI:1568511715
Name:WILHELM, DEBRA ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANN
Last Name:WILHELM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:BODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:6601 VENTNOR AVENUE
Mailing Address - Street 2:TROY AVENUE ST14
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406
Mailing Address - Country:US
Mailing Address - Phone:609-487-6507
Mailing Address - Fax:
Practice Address - Street 1:6601 VENTNOR AVE
Practice Address - Street 2:TROY AVENUE ST14
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2167
Practice Address - Country:US
Practice Address - Phone:609-487-6507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07804900363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1740230952OtherGROUP PRACTICE NPI