Provider Demographics
NPI:1194727370
Name:LUBOW, DEBORAH SKOOTSKY (RN , CRNP,)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SKOOTSKY
Last Name:LUBOW
Suffix:
Gender:F
Credentials:RN , CRNP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5711 OAKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4217
Mailing Address - Country:US
Mailing Address - Phone:410-367-7776
Mailing Address - Fax:410-605-7691
Practice Address - Street 1:3900 LOCH RAVEN BLVD
Practice Address - Street 2:BLDG 2
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2108
Practice Address - Country:US
Practice Address - Phone:410-605-7630
Practice Address - Fax:410-605-7691
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR110361363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology