Provider Demographics
NPI:1063097061
Name:PERSYN, DEBORAH MERCY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MERCY
Last Name:PERSYN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7935 ECHO WIND ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-4710
Mailing Address - Country:US
Mailing Address - Phone:210-379-8494
Mailing Address - Fax:
Practice Address - Street 1:7935 ECHO WIND ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-4710
Practice Address - Country:US
Practice Address - Phone:210-379-8494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-301024163WL0100X
TX901128163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant