Provider Demographics
NPI:1811984933
Name:HUBER, DEBORAH ELISE (CNM, RN, NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELISE
Last Name:HUBER
Suffix:
Gender:F
Credentials:CNM, RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-887-2530
Practice Address - Fax:570-887-2904
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380076-1163W00000X
NY420612-1363LW0102X
PAMW010186367A00000X
NYF000893-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00091755001OtherHEALTHNOW PROVIDER ID#
NYAA0598OtherMEDICARE GROUP PIN
NY1899853OtherGHI PPO PROVIDER ID#
NY161568690OtherUNITED HEALTHCARE ID#
PAGU039794OtherMEDICARE GROUP PIN
NY02053294Medicaid
NY000025708OtherBCBS PROVIDER ID#
PA1009449830001Medicaid
NY1899853OtherGHI PPO PROVIDER ID#
NY00091755001OtherHEALTHNOW PROVIDER ID#
NYJ400001781Medicare PIN