Provider Demographics
NPI:1689864308
Name:WOOLLEY, DEBORAH LOUISE (CNM)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LOUISE
Last Name:WOOLLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:WOOLLEY
Other - Last Name:PERLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:301 GREAT TEAYS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9552
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-201-5019
Practice Address - Street 1:301 GREAT TEAYS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9552
Practice Address - Country:US
Practice Address - Phone:304-757-6999
Practice Address - Fax:304-201-5019
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000127A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200870260Medicaid
WV3810026505Medicaid
WVQ44849DMedicare PIN
IN130910TMedicare PIN
IN200870260Medicaid
CADH545ZMedicare PIN
Q44849AMedicare UPIN
IN854700WWWMedicare PIN
WV3810026505Medicaid
IN941090Y5Medicare PIN
WVQ44849EMedicare PIN
IN252060SMedicare PIN
WVQ44849GMedicare PIN
WVQ44849FMedicare PIN