Provider Demographics
NPI:1922651082
Name:WEBER, DEBORAH A (PMHNP, CPNP, RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:WEBER
Suffix:
Gender:F
Credentials:PMHNP, CPNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3188
Mailing Address - Country:US
Mailing Address - Phone:410-535-3047
Mailing Address - Fax:410-535-3890
Practice Address - Street 1:480 LAKE DR
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-3260
Practice Address - Country:US
Practice Address - Phone:410-207-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR084330363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics