Basic Information
| Provider Information | |||||||||
| NPI: | 1982798138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITCOMB | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 MAIN ST N | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550826785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513421039 | ||||||||
| FaxNumber: | 6513421428 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 MAIN N ST 300 | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550826788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513421039 | ||||||||
| FaxNumber: | 6513421428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 9719 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | HP35074 | 01 | MN | HEALTHPARTNERS | OTHER | 0110221 | 01 | MN | MEDICA | OTHER | 043830800 | 05 | MN | MEDICAID | 59G80WH | 01 | MN | BCBS OF MN | OTHER | 1030717 | 01 | MN | PREFERRED ONE | OTHER | 1612603 | 01 | MN | AMERICA'S PPO | OTHER | 141701 | 01 | MN | UCARE MN | OTHER | 6608281 | 01 | MN | MEDICA URGENT CARE | OTHER |