Provider Demographics
NPI:1043534050
Name:HAWRYSKO, DEBRA JOY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JOY
Last Name:HAWRYSKO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 VILLA LN
Mailing Address - Street 2:UNIT C
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6573
Mailing Address - Country:US
Mailing Address - Phone:434-996-0189
Mailing Address - Fax:
Practice Address - Street 1:1244 VILLA LN
Practice Address - Street 2:UNIT C
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6573
Practice Address - Country:US
Practice Address - Phone:434-996-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001145056163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0160211485Medicaid