Provider Demographics
NPI:1578524641
Name:DANZINGER, DEBRA FAYE (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:FAYE
Last Name:DANZINGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:FAYE
Other - Last Name:KEATHLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:323 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:KY
Mailing Address - Zip Code:40051-6319
Mailing Address - Country:US
Mailing Address - Phone:502-350-5191
Mailing Address - Fax:502-549-6599
Practice Address - Street 1:323 CENTER ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:KY
Practice Address - Zip Code:40051-6319
Practice Address - Country:US
Practice Address - Phone:502-350-5191
Practice Address - Fax:502-549-6599
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3601P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYAB52OtherANTHEM
KY1153758OtherPASSPORT
KY78006632Medicaid
KY1153758OtherPASSPORT
KY78006632Medicaid