Provider Demographics
NPI:1881981330
Name:DIBARTOLO, DEBRA JEAN (FNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEAN
Last Name:DIBARTOLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5432
Mailing Address - Country:US
Mailing Address - Phone:607-273-5500
Mailing Address - Fax:607-273-1277
Practice Address - Street 1:334 W STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5432
Practice Address - Country:US
Practice Address - Phone:607-273-5500
Practice Address - Fax:607-273-1277
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY458367-1101YA0400X
NY404946363LP0808X
NYF337369-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health