Provider Demographics
NPI:1104153816
Name:LESSNER, DEBRA ANN (FNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:LESSNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:GAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1434 BANKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-5833
Mailing Address - Country:US
Mailing Address - Phone:219-771-5585
Mailing Address - Fax:
Practice Address - Street 1:1434 BANKSIDE LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-5833
Practice Address - Country:US
Practice Address - Phone:219-771-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1104153816OtherVHA
INM400058763Medicare PIN
INM400058760Medicare PIN
INM400058762Medicare PIN