Provider Demographics
NPI:1134354731
Name:SLATER, DEBRA (NP)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:SLATER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 BEACH 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-471-3571
Mailing Address - Fax:718-471-0314
Practice Address - Street 1:821 BAY 25TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1800
Practice Address - Country:US
Practice Address - Phone:718-471-3571
Practice Address - Fax:718-471-0314
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420009-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health