Provider Demographics
NPI:1831149319
Name:PASCHAL, DEBRA B (CERTIFIED NURSE PRAC)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:B
Last Name:PASCHAL
Suffix:
Gender:F
Credentials:CERTIFIED NURSE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-5430
Mailing Address - Country:US
Mailing Address - Phone:478-986-4743
Mailing Address - Fax:478-986-3921
Practice Address - Street 1:260 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5430
Practice Address - Country:US
Practice Address - Phone:478-986-4743
Practice Address - Fax:478-986-3921
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN060102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52023632OtherBCBS
D39498Medicare UPIN
GAGRP3871Medicare ID - Type Unspecified