Provider Demographics
NPI:1780019828
Name:WASNOCK, DEBORAH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WASNOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 LEWIS LAKE RD
Mailing Address - Street 2:PO BOX 71
Mailing Address - City:UNION DALE
Mailing Address - State:PA
Mailing Address - Zip Code:18470-4541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1424 LEWIS LAKE RD
Practice Address - Street 2:
Practice Address - City:UNION DALE
Practice Address - State:PA
Practice Address - Zip Code:18470-4541
Practice Address - Country:US
Practice Address - Phone:570-960-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN252562L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse