Provider Demographics
NPI:1790717551
Name:BIALAS, DEBORAH CANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:CANN
Last Name:BIALAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4904
Mailing Address - Country:US
Mailing Address - Phone:814-723-0273
Mailing Address - Fax:
Practice Address - Street 1:103 ST CLAIR ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2197
Practice Address - Country:US
Practice Address - Phone:814-726-0273
Practice Address - Fax:814-726-0694
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004391B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA059103001Medicaid
S55721Medicare UPIN
008818JVYMedicare ID - Type Unspecified