Provider Demographics
NPI:1770836694
Name:DESHANE, MARGARET ELISABETH (FPMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELISABETH
Last Name:DESHANE
Suffix:
Gender:F
Credentials:FPMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2024
Mailing Address - Country:US
Mailing Address - Phone:417-256-6762
Mailing Address - Fax:
Practice Address - Street 1:909 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2024
Practice Address - Country:US
Practice Address - Phone:417-256-6762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012032144363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health