Provider Demographics
NPI: | 1750482014 |
---|---|
Name: | LENTNER, DEBORAH P (PA) |
Entity Type: | Individual |
Prefix: | |
First Name: | DEBORAH |
Middle Name: | P |
Last Name: | LENTNER |
Suffix: | |
Gender: | F |
Credentials: | PA |
Other - Prefix: | |
Other - First Name: | DEBORAH |
Other - Middle Name: | H |
Other - Last Name: | PRESS |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | PA |
Mailing Address - Street 1: | PO BOX 1369 |
Mailing Address - Street 2: | |
Mailing Address - City: | PRINCETON |
Mailing Address - State: | WV |
Mailing Address - Zip Code: | 24740-1369 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 304-487-3407 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 122 12TH ST STE A |
Practice Address - Street 2: | |
Practice Address - City: | PRINCETON |
Practice Address - State: | WV |
Practice Address - Zip Code: | 24740-2312 |
Practice Address - Country: | US |
Practice Address - Phone: | 304-487-3407 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-26 |
Last Update Date: | 2018-09-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WV | 748 | 363AM0700X |
PA | OX01107 | 363AS0400X, 363AM0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 310443WDY | Medicare PIN |