Provider Demographics
NPI:1245205418
Name:BISSONNETTE, DEBORA LEE (CNM)
Entity type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:LEE
Last Name:BISSONNETTE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BURDETT
Mailing Address - State:NY
Mailing Address - Zip Code:14818
Mailing Address - Country:US
Mailing Address - Phone:607-546-7936
Mailing Address - Fax:607-546-7938
Practice Address - Street 1:3812 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BURDETT
Practice Address - State:NY
Practice Address - Zip Code:14818
Practice Address - Country:US
Practice Address - Phone:607-546-7936
Practice Address - Fax:607-546-7938
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2009-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000956367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife