1548401706 NPI number — MS. DEBORAH DELIGHT TROY ANP-BC; PMHNP-BC

Table of content: MS. DEBORAH DELIGHT TROY ANP-BC; PMHNP-BC (NPI 1548401706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548401706 NPI number — MS. DEBORAH DELIGHT TROY ANP-BC; PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROY
Provider First Name:
DEBORAH
Provider Middle Name:
DELIGHT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ANP-BC; PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548401706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 6TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASS LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56633-3428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-335-3050
Provider Business Mailing Address Fax Number:
218-335-4410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 6TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASS LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56633-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-335-3050
Provider Business Practice Location Address Fax Number:
218-335-4410
Provider Enumeration Date:
03/18/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  2008011658 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: R-153536-7 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 2012005172 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)