Provider Demographics
NPI:1639248768
Name:PRIBULICK, DEBORAH L (NP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:L
Last Name:PRIBULICK
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:28538 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4791
Practice Address - Country:US
Practice Address - Phone:302-934-0944
Practice Address - Fax:302-934-0920
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF320061363L00000X
DELG0011474363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC9269OtherRR MEDICARE GROUP
PWGU039823OtherPA MEDICARE GROUP
NY02838640Medicaid
PAP00379060OtherRR MEDICARE PIN
PAP00379060OtherRR MEDICARE PIN
NYRB2998Medicare PIN