Provider Demographics
NPI:1700991437
Name:MCINTOSH, DEBORAH K (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:K
Last Name:MCINTOSH
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 1:80 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-8334
Mailing Address - Country:US
Mailing Address - Phone:209-327-1862
Mailing Address - Fax:
Practice Address - Street 1:80 WESTBROOK DR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-8334
Practice Address - Country:US
Practice Address - Phone:209-327-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476646163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory