Provider Demographics
NPI:1629041371
Name:CASTELLUCCI, DEBORAH T (CRNP, PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:T
Last Name:CASTELLUCCI
Suffix:
Gender:F
Credentials:CRNP, PHD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:T
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP, PHD
Mailing Address - Street 1:1320 BROADCASTING RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3222
Mailing Address - Country:US
Mailing Address - Phone:610-372-8995
Mailing Address - Fax:
Practice Address - Street 1:1320 BROADCASTING RD
Practice Address - Street 2:STE 200
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3222
Practice Address - Country:US
Practice Address - Phone:610-372-8995
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP001119H363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA675072Medicare ID - Type Unspecified
R08494Medicare UPIN