Provider Demographics
NPI:1376680264
Name:COFFEE, DEBRA MARGARET (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MARGARET
Last Name:COFFEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:MARGARET
Other - Last Name:COFFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15712 E WILLIS RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-7514
Mailing Address - Country:US
Mailing Address - Phone:480-988-9564
Mailing Address - Fax:
Practice Address - Street 1:423 E SETTLERS POINT DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3437
Practice Address - Country:US
Practice Address - Phone:480-507-1481
Practice Address - Fax:480-507-1550
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP008693376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide