Provider Demographics
NPI:1780749044
Name:CRIVELLO, DEBORAH (CRNP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:CRIVELLO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 PULASKI HWY
Mailing Address - Street 2:STE 207
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2143
Mailing Address - Country:US
Mailing Address - Phone:443-843-6100
Mailing Address - Fax:443-843-6130
Practice Address - Street 1:2027 PULASKI HWY
Practice Address - Street 2:STE 207
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2143
Practice Address - Country:US
Practice Address - Phone:443-843-6100
Practice Address - Fax:443-843-6130
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR050918363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P46730Medicare UPIN
K679C669Medicare ID - Type Unspecified
S883N691Medicare ID - Type Unspecified