Provider Demographics
NPI:1417535766
Name:DEBORD, EMILY ROSE (LPN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:DEBORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 KILLARNEY TRL
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8857
Mailing Address - Country:US
Mailing Address - Phone:361-648-4007
Mailing Address - Fax:
Practice Address - Street 1:306 KILLARNEY TRL
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-8857
Practice Address - Country:US
Practice Address - Phone:361-648-4007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0063835164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse