Provider Demographics
NPI:1952407785
Name:HOMER, DEBORAH S (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:HOMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1024
Mailing Address - Country:US
Mailing Address - Phone:508-839-2240
Mailing Address - Fax:
Practice Address - Street 1:100 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1024
Practice Address - Country:US
Practice Address - Phone:508-839-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA141024363LA2100X, 363LF0000X
CT005678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA500011234OtherRAILROAD
MAHO NP2229Medicare ID - Type Unspecified