Provider Demographics
NPI:1427148188
Name:SALA, DEBRA JEAN (CNM)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JEAN
Last Name:SALA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:SALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:1823 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3069
Mailing Address - Country:US
Mailing Address - Phone:940-483-1569
Mailing Address - Fax:940-483-1570
Practice Address - Street 1:1823 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3069
Practice Address - Country:US
Practice Address - Phone:940-483-1569
Practice Address - Fax:940-483-1570
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX509224367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N4943OtherBCBS PROVIDER NUMBER
TX10029901OtherAMERIGROUP
TX0039KZOtherBCBS GROUP
TX0039KZOtherBCBS GROUP
TX10029901OtherAMERIGROUP
TXR95065Medicare UPIN