Provider Demographics
NPI:1376550863
Name:RADOMSKI, DEBRA LYNN (APRN-BC GNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:RADOMSKI
Suffix:
Gender:F
Credentials:APRN-BC GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W BAY AREA BLVD
Mailing Address - Street 2:SUIT 500
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4043
Mailing Address - Country:US
Mailing Address - Phone:281-554-2200
Mailing Address - Fax:
Practice Address - Street 1:711 W BAY AREA BLVD
Practice Address - Street 2:SUIT 500
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4043
Practice Address - Country:US
Practice Address - Phone:281-554-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253968363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038057802Medicaid
TX8J6925Medicare PIN
TXS38778Medicare UPIN