Provider Demographics
NPI:1225472103
Name:FORDHAM, DEBRA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:FORDHAM
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 1:615 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-1854
Mailing Address - Country:US
Mailing Address - Phone:360-606-2191
Mailing Address - Fax:
Practice Address - Street 1:615 W 39TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1854
Practice Address - Country:US
Practice Address - Phone:360-606-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00149046163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse