Basic Information
| Provider Information | |||||||||
| NPI: | 1114902277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PITTILLO | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | WHITMIRE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 27877 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286948350 | ||||||||
| FaxNumber: | 8286947654 | ||||||||
| Practice Location | |||||||||
| Address1: | 2695 HENDERSONVILLE RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287048576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286846035 | ||||||||
| FaxNumber: | 8286548152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201649 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 611186890 | 01 | PRIVATE HEALTHCARE SAVING | OTHER | 611186890 | 01 | BEECH STREET | OTHER | 500030491 | 01 | RR MEDICARE | OTHER | 611186890 | 01 | HUMANA TRICARE | OTHER | 611186890 | 01 | CIGNA HEALTHCARE | OTHER | C0039 | 01 | MEDCOST | OTHER | NCX355A | 01 | NC | MEDICARE PTAN | OTHER | 0171701 | 01 | UNITED HEALTHCARE | OTHER | O12U9 | 01 | BCBS NC | OTHER | 7000364 | 05 | NC | MEDICAID | NP0683 | 05 | SC | MEDICAID | 611186890 | 01 | FIRST HEALTH | OTHER | 611186890 | 01 | HEALTHCARE SAVINGS | OTHER | 611186890 | 01 | CRESENT | OTHER |