Doctor Name: | LUANN DEAFENBAUGH |
NPI Number: | 1003058454 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 28067608 |
Business Practice Address: | 1520 Provident Dr Warsaw, IN - 465803291 |
Business Phone Number: | 5743723800 |
Business Fax Number: | 5743725823 |
Mailing Address: | 1520 Provident Dr, WARSAW |
State: | IN |
Postal Code: | 465803291 |
Phone Number: | 5743723800 |
Fax Number: | 5743725823 |
NPI Enumeration Date: | 04/01/2009 |
NPI Last Update Date: | 08/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 28067608 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |