Provider Demographics
NPI:1255339479
Name:POSTHUMUS, DEBORAH ANN (PA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:POSTHUMUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:STAYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:6207 HARVEY ST
Practice Address - Street 2:STE A
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-7861
Practice Address - Country:US
Practice Address - Phone:231-799-2515
Practice Address - Fax:231-799-2618
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S29553Medicare UPIN