Provider Demographics
NPI:1427672799
Name:WINN, DEBORAH MARIE
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARIE
Last Name:WINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64237
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728-4237
Mailing Address - Country:US
Mailing Address - Phone:520-235-1645
Mailing Address - Fax:520-849-7595
Practice Address - Street 1:2960 N SWAN RD STE 214
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6020
Practice Address - Country:US
Practice Address - Phone:520-235-1645
Practice Address - Fax:520-849-7595
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3005326171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor