Provider Demographics
NPI:1063698769
Name:GATES, DEBRA J (NURSE PRACTITIONER A)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:GATES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ROE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1629
Mailing Address - Country:US
Mailing Address - Phone:607-795-2820
Mailing Address - Fax:607-795-2821
Practice Address - Street 1:RRHS CLIFTON SPRINGS HOSPITAL AND CLINIC - ENDOCRINE
Practice Address - Street 2:2 COULTER RD
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432
Practice Address - Country:US
Practice Address - Phone:315-462-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301635363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P019301635OtherBLUE CHOICE
217858BSOtherPREFERRED CARE