Provider Demographics
NPI:1760413397
Name:BELLINGHAM, DEBRA KAY MAAS (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY MAAS
Last Name:BELLINGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:KAY
Other - Last Name:MAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356-9714
Mailing Address - Country:US
Mailing Address - Phone:952-221-0781
Mailing Address - Fax:
Practice Address - Street 1:148 GLENDALE DR
Practice Address - Street 2:
Practice Address - City:LONG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55356-9714
Practice Address - Country:US
Practice Address - Phone:952-221-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN216924000Medicaid
MN216924000Medicaid