Provider Demographics
NPI:1720097389
Name:KORBITZ, DEBORAH S (CNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:KORBITZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:S
Other - Last Name:BJERSTEDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:9401 JAMES AVE S STE 162
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:967 LAKE ST S
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025
Practice Address - Country:US
Practice Address - Phone:651-464-1113
Practice Address - Fax:651-464-0853
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5429363LF0000X
NMCNP-01924363LF0000X
AZAP2952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1720097389Medicaid
AZZ132194Medicare PIN