Provider Demographics
NPI:1619054368
Name:TREMBLAY, DEBORAH (NP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1737
Mailing Address - Country:US
Mailing Address - Phone:508-828-5020
Mailing Address - Fax:866-262-4460
Practice Address - Street 1:416 BROADWAY
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1737
Practice Address - Country:US
Practice Address - Phone:508-828-5020
Practice Address - Fax:866-262-4460
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156719363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP2319Medicare ID - Type Unspecified
MAP03093Medicare UPIN