Provider Demographics
NPI:1568696599
Name:CIESLA, DEBORAH ANN (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:CIESLA
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDMT
Mailing Address - Street 1:7985 BROWNING ST BLDG 1781
Mailing Address - Street 2:
Mailing Address - City:HILL AFB
Mailing Address - State:UT
Mailing Address - Zip Code:84056-5912
Mailing Address - Country:US
Mailing Address - Phone:801-777-5501
Mailing Address - Fax:801-777-8143
Practice Address - Street 1:7985 BROWNING ST BLDG 1781
Practice Address - Street 2:
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-5912
Practice Address - Country:US
Practice Address - Phone:801-777-5501
Practice Address - Fax:801-777-8143
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians