Provider Demographics
NPI:1770695827
Name:MAHONEY, DEBORAH JUNE (APRN BC)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JUNE
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-353-6314
Mailing Address - Fax:319-353-7788
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-6314
Practice Address - Fax:319-353-7788
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4007271363L00000X
IAG116536363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
536497OtherCDPHP
7348759OtherVALUEOPTIONS - EMPIRE GHI
1033150OtherBEACON HEALTH STRAT
370612OtherMVP HEALTH CARE
536497OtherVALUEOPTIONS
7293684OtherAETNA
2238578OtherCIGNA BEH HEALTH
560713000OtherMAGELLAN
2238578OtherCIGNA BEH HEALTH
370612OtherMVP HEALTH CARE
IAI0923154Medicare PIN
NY0492G32322Medicare PIN