Provider Demographics
NPI:1821532912
Name:RAFFO, DEBRA PHYLLIS (NP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:PHYLLIS
Last Name:RAFFO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:PHYLLIS
Other - Last Name:RAFFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1 E BROAD ST STE 130
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5934
Mailing Address - Country:US
Mailing Address - Phone:484-626-0480
Mailing Address - Fax:484-896-9002
Practice Address - Street 1:3477 CORPORATE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-8237
Practice Address - Country:US
Practice Address - Phone:484-626-0480
Practice Address - Fax:484-896-9002
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAG1016144363LG0600X
PASP01729363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology