Provider Demographics
NPI:1407116312
Name:REDFERN, DEBRA (RN, CCM, QRP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:REDFERN
Suffix:
Gender:F
Credentials:RN, CCM, QRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 562746
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28256-2746
Mailing Address - Country:US
Mailing Address - Phone:704-980-9493
Mailing Address - Fax:704-973-9493
Practice Address - Street 1:9905 MATTIE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4719
Practice Address - Country:US
Practice Address - Phone:704-980-9493
Practice Address - Fax:704-973-9493
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator