Provider Demographics
NPI:1841245115
Name:RIEMER, DEBORAH WOLTERSDORT (PA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:WOLTERSDORT
Last Name:RIEMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 COLONNADE PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2382
Mailing Address - Country:US
Mailing Address - Phone:205-510-5000
Mailing Address - Fax:205-599-9080
Practice Address - Street 1:3980 COLONNADE PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2382
Practice Address - Country:US
Practice Address - Phone:205-510-5000
Practice Address - Fax:205-599-9080
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-117363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000033519Medicaid