Provider Demographics
NPI:1972562858
Name:BEALL, DEBORAH LU (APN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LU
Last Name:BEALL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5200
Mailing Address - Country:US
Mailing Address - Phone:907-563-2929
Mailing Address - Fax:907-563-0748
Practice Address - Street 1:4001 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5200
Practice Address - Country:US
Practice Address - Phone:907-563-2929
Practice Address - Fax:907-563-0748
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN000005457363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB0718621OtherDEA
MB0718621OtherDEA