Provider Demographics
NPI:1275846255
Name:TATNALL, DEBRA RICHARDS (CS)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:RICHARDS
Last Name:TATNALL
Suffix:
Gender:F
Credentials:CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 METACOMET ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1256
Mailing Address - Country:US
Mailing Address - Phone:508-641-6943
Mailing Address - Fax:
Practice Address - Street 1:40 GROVE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7702
Practice Address - Country:US
Practice Address - Phone:508-641-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Single Specialty
No282J00000XHospitalsReligious Nonmedical Health Care Institution