Provider Demographics
NPI:1760556435
Name:MALONE, DEBORAH WARREN (WHCNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:WARREN
Last Name:MALONE
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:COLLEEN
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:712 JAY ST
Mailing Address - Street 2:ASHER COMMUNITY HEALTH CENTER
Mailing Address - City:FOSSIL
Mailing Address - State:OR
Mailing Address - Zip Code:97830
Mailing Address - Country:US
Mailing Address - Phone:541-763-2725
Mailing Address - Fax:
Practice Address - Street 1:712 JAY ST
Practice Address - Street 2:ASHER COMMUNITY HEALTH CENTER
Practice Address - City:FOSSIL
Practice Address - State:OR
Practice Address - Zip Code:97830
Practice Address - Country:US
Practice Address - Phone:541-763-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR085075581N7 WHCNP PP363L00000X
OR085075581N7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR124524Medicaid
OR124524Medicaid
P34409Medicare UPIN