Provider Demographics
NPI:1790762557
Name:HENRY, DEBORAH LEIGH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEIGH
Last Name:HENRY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2840 SMOKEHOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-7030
Mailing Address - Country:US
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Practice Address - Street 1:310 W LOSEY ST
Practice Address - Street 2:
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5250
Practice Address - Country:US
Practice Address - Phone:618-256-6267
Practice Address - Fax:618-256-7931
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant