Individual
DEBORAH FORTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP-BC
Contact information
Practice address
451 CLARKSON AVE, BROOKLYN, NY 11203-2097
(718) 245-3131
Mailing address
67 HAVEN AVE, VALLEY STREAM, NY 11580-3238
(646) 361-4502
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
617528
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
202121416
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000000
N/A
—
Enumeration date
07/12/2022
Last updated
07/12/2022
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