Provider Demographics
NPI:1669575692
Name:GOLDSTEIN, DEBRA ANN (CNM)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:JUNKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14104 N.W. 10TH COURT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685
Mailing Address - Country:US
Mailing Address - Phone:360-258-4928
Mailing Address - Fax:
Practice Address - Street 1:12607 S.E. MILL PLAIN BLVD.
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:360-418-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005883363LF0000X, 367A00000X
OR077037780N1363LF0000X
OR077037780N5367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife