Provider Demographics
NPI:1194718387
Name:BODY, DEBORAH ANNE (DNP, FNP-C)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANNE
Last Name:BODY
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-2502
Mailing Address - Country:US
Mailing Address - Phone:518-554-8087
Mailing Address - Fax:518-359-4133
Practice Address - Street 1:2445 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-2502
Practice Address - Country:US
Practice Address - Phone:518-554-8087
Practice Address - Fax:518-359-4133
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY438972163W00000X
NY331877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ2620560Medicaid