Provider Demographics
NPI:1033687439
Name:DEBRA VIDRINE, HEALTH CARE SERVICES,LLC
Entity Type:Organization
Organization Name:DEBRA VIDRINE, HEALTH CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA VIDRINE
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:VIDRINE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:337-363-5592
Mailing Address - Street 1:1039 RIVER BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-1906
Mailing Address - Country:US
Mailing Address - Phone:337-831-1416
Mailing Address - Fax:
Practice Address - Street 1:1535 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-2867
Practice Address - Country:US
Practice Address - Phone:337-363-5592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265506984OtherNPI