Provider Demographics
NPI:1568580116
Name:BURTON, DEBORAH ANN
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:BOUOWVUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:1640 EMPEROR WAY
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576
Mailing Address - Country:US
Mailing Address - Phone:907-842-2587
Mailing Address - Fax:
Practice Address - Street 1:6000 KANAKANAK ROAD
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-9218
Practice Address - Fax:907-842-9250
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK50231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAU0050Medicaid
AK020021Medicare ID - Type Unspecified