Provider Demographics
NPI:1902867245
Name:RUPAE, DEBORAH KATHLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KATHLEEN
Last Name:RUPAE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13995 W. STATLER BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5501
Mailing Address - Country:US
Mailing Address - Phone:623-478-3100
Mailing Address - Fax:623-478-3300
Practice Address - Street 1:13995 W. STATLER BLVD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-478-3100
Practice Address - Fax:623-478-3300
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005854363LF0000X
OR200150031NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9645714Medicaid
WA8801758Medicare PIN
WAQ09642Medicare UPIN
ORR154096Medicare PIN