National Provider Identifier
Laura Marjorie Debacco, PA-C
Laura Marjorie Debacco, PA-C is listed in the NPPES registry with a primary specialty of Physician Assistant in Lewiston, NY and a listed phone number of (716) 297-9379.
Profile Overview
- NPI
- 1386955748
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- June 30, 2010
- Last Updated
- December 08, 2022
Practice Location
- 5927 Military RD
- Lewiston, NY 14092-2218
Phone: (716) 297-9379
Specialties
- Physician Assistant (363A00000X)
Full Record
- NPI
- 1386955748
- Entity Type
- Individual
- Last Name
- Debacco
- First Name
- Laura
- Middle Name
- Marjorie
- Credential
- PA-C
- Provider Other Last Name
- Malysza
- Provider Other First Name
- Laura
- Provider Other Middle Name
- Marjorie
- Provider Other Credential Text
- RPA-C
- Provider Other Last Name Type Code
- 5
- Mailing Street Address
- 5927 Military RD
- Mailing City
- Lewiston
- Mailing State
- NY
- Mailing ZIP Code
- 14092-2218
- Mailing Country
- US
- Mailing Phone
- (716) 297-9379
- Mailing Fax
- (716) 297-4638
- Practice Street Address
- 5927 Military RD
- Practice City
- Lewiston
- Practice State
- NY
- Practice ZIP Code
- 14092-2218
- Practice Country
- US
- Practice Phone
- (716) 297-9379
- Practice Fax
- (716) 297-4638
- Enumeration Date
- June 30, 2010
- Last Updated
- December 08, 2022
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- December 08, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X)
- Other Identifiers
- 03326510 (NY)