Basic Information
| Provider Information | |||||||||
| NPI: | 1700022787 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZELISSE | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | SWR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 745 W MOANA LN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895094991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753343033 | ||||||||
| FaxNumber: | 7753343022 | ||||||||
| Practice Location | |||||||||
| Address1: | 745 W MOANA LN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895094991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753343033 | ||||||||
| FaxNumber: | 7753343022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2008 | ||||||||
| LastUpdateDate: | 12/23/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 1399 SW | NV | Y | Agencies | Case Management |
No ID Information.