Provider Demographics
NPI:1780820332
Name:BLACK, DEBORAH SINCLAIR (WHNP-BC, APNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:SINCLAIR
Last Name:BLACK
Suffix:
Gender:F
Credentials:WHNP-BC, APNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:BLACK
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC, APNP
Mailing Address - Street 1:2962 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1640
Mailing Address - Country:US
Mailing Address - Phone:414-232-1537
Mailing Address - Fax:
Practice Address - Street 1:2356 S 102ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-2104
Practice Address - Country:US
Practice Address - Phone:414-336-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67447363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health