Provider Demographics
NPI:1821118969
Name:MCCARTHY, DEBORAH SUE (RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44905 CARVER DR
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6742
Mailing Address - Country:US
Mailing Address - Phone:907-260-7442
Mailing Address - Fax:
Practice Address - Street 1:44905 CARVER DR
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6742
Practice Address - Country:US
Practice Address - Phone:907-260-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10770171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG624Medicaid
AKCM6242Medicaid