Provider Demographics
NPI:1255542437
Name:DEITZ, SHEILA DEBOSE
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:DEBOSE
Last Name:DEITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:DEBOSE
Other - Last Name:DEITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NNP
Mailing Address - Street 1:515 SEA CASTLE CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3280
Mailing Address - Country:US
Mailing Address - Phone:910-791-3915
Mailing Address - Fax:
Practice Address - Street 1:2131 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7407
Practice Address - Country:US
Practice Address - Phone:910-343-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC071890363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal