Provider Demographics
NPI:1619210952
Name:UTPADEL, DEBRA ANNE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANNE
Last Name:UTPADEL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 N MELODY ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3343
Mailing Address - Country:US
Mailing Address - Phone:512-947-8371
Mailing Address - Fax:
Practice Address - Street 1:1309 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-6486
Practice Address - Country:US
Practice Address - Phone:936-560-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2024-04-02
Deactivation Date:2022-07-01
Deactivation Code:
Reactivation Date:2022-08-01
Provider Licenses
StateLicense IDTaxonomies
NVRN67133163W00000X
AZRN167697163W00000X
AZAP5114363LA2200X
CA789586163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse