Provider Demographics
NPI:1952425126
Name:GLEASON, DEBORAH L (PNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:GLEASON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:MORGAN-GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1204 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2824
Practice Address - Country:US
Practice Address - Phone:434-924-0123
Practice Address - Fax:434-243-3300
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024141256363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010216419Medicaid
VAC06115OtherGROUP PTAN
VAC06115OtherGROUP PTAN