Provider Demographics
NPI:1609159730
Name:PETERSON, DEBORAH ANN (PA)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5540 PEBBLE VILLAGE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7411
Mailing Address - Country:US
Mailing Address - Phone:317-900-4060
Mailing Address - Fax:317-900-4698
Practice Address - Street 1:5540 PEBBLE VILLAGE LN STE 200
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7411
Practice Address - Country:US
Practice Address - Phone:317-900-4060
Practice Address - Fax:317-900-4698
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001332A363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant