Provider Demographics
NPI:1154818540
Name:SMITH, DEBRA LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 248TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-6769
Mailing Address - Country:US
Mailing Address - Phone:253-389-7768
Mailing Address - Fax:
Practice Address - Street 1:10601 248TH STREET CT E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-6769
Practice Address - Country:US
Practice Address - Phone:253-389-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00134348163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse