Provider Demographics
NPI:1962405688
Name:HAUBERT, DEBORAH ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:HAUBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:ANNE
Other - Last Name:MOTYL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-759-7596
Mailing Address - Fax:336-759-3652
Practice Address - Street 1:1995 BETHABARA RD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3375
Practice Address - Country:US
Practice Address - Phone:336-759-7596
Practice Address - Fax:336-759-3652
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102304363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1962405688OtherRAILROAD MEDICARE
NC8101293Medicaid
NC2751183BMedicare PIN