Provider Demographics
NPI:1215246707
Name:DEBORAH C. GOOTEE CRNP-PMH, LLC
Entity type:Organization
Organization Name:DEBORAH C. GOOTEE CRNP-PMH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOOTEE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:410-745-5595
Mailing Address - Street 1:PO BOX 1264
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-1264
Mailing Address - Country:US
Mailing Address - Phone:410-745-5595
Mailing Address - Fax:410-745-5855
Practice Address - Street 1:103 EAST CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:SAINT MICHAELS
Practice Address - State:MD
Practice Address - Zip Code:21663
Practice Address - Country:US
Practice Address - Phone:410-745-5595
Practice Address - Fax:410-745-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR053273363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty