Individual
MISS DEBORAH MARISA PROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
2076 HWY 42 WEST, SUITE 300, CLAYTON, NC 27520-5302
(919) 220-5255
Mailing address
PO BOX 5105, BELFAST, ME 04915-5100
(919) 220-5255
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
0010-06287
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-06287
MEDICAL LICENSE
NC
Enumeration date
09/22/2006
Last updated
10/13/2021
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