Provider Demographics
NPI:1982798138
Name:WHITCOMB, DEBORAH L (PA-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:WHITCOMB
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21365 IVERSON AVE N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-9557
Mailing Address - Country:US
Mailing Address - Phone:651-387-8947
Mailing Address - Fax:
Practice Address - Street 1:21365 IVERSON AVE N
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-9557
Practice Address - Country:US
Practice Address - Phone:651-387-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9719363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP35074OtherHEALTHPARTNERS
MN043830800Medicaid
MN0110221OtherMEDICA
MN141701OtherUCARE MN
MNHP35074OtherHEALTHPARTNERS
MN043830800Medicaid
MN141701OtherUCARE MN
MN1030717OtherPREFERRED ONE
MN6608281OtherMEDICA URGENT CARE
MN970024451Medicare ID - Type UnspecifiedRR MEDICARE
MN59G80WHOtherBCBS OF MN