Provider Demographics
NPI:1063482537
Name:SPEETER, DEBBERA J (NP)
Entity Type:Individual
Prefix:
First Name:DEBBERA
Middle Name:J
Last Name:SPEETER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 STADIUM DR # 42
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9423
Mailing Address - Country:US
Mailing Address - Phone:269-488-8844
Mailing Address - Fax:269-488-8845
Practice Address - Street 1:7110 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009
Practice Address - Country:US
Practice Address - Phone:269-488-8844
Practice Address - Fax:269-488-8845
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704119224363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4500721Medicaid
MI(D) 4500712Medicaid
MI4500721Medicaid