Provider Demographics
NPI:1215667670
Name:TRAUGH, DEBORAH A (RN LMT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:TRAUGH
Suffix:
Gender:F
Credentials:RN LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 COLUMBIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8859
Mailing Address - Country:US
Mailing Address - Phone:570-784-1366
Mailing Address - Fax:
Practice Address - Street 1:1235 COLUMBIA BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8859
Practice Address - Country:US
Practice Address - Phone:570-784-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN188720L163W00000X
PAMSG002650163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse