Provider Demographics
NPI:1265892970
Name:LANDERS, DEBORAH (ANP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:LANDERS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ASHLEY
Other - Last Name:JOHNSTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-368-3506
Mailing Address - Fax:585-368-3163
Practice Address - Street 1:1561 LONG POND RD STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4135
Practice Address - Country:US
Practice Address - Phone:585-368-3506
Practice Address - Fax:585-368-3163
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307439363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV04340098Medicaid
NV04340098Medicaid
NYJ400283724-GRPBA0017Medicare PIN