Provider Demographics
NPI:1154381150
Name:STANG, DEBORAH J (NP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:J
Last Name:STANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:86 BAKER AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2132
Mailing Address - Country:US
Mailing Address - Phone:978-287-9400
Mailing Address - Fax:978-287-9408
Practice Address - Street 1:86 BAKER AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2132
Practice Address - Country:US
Practice Address - Phone:978-287-9400
Practice Address - Fax:978-287-9408
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA136010363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS59833Medicare UPIN