Provider Demographics
NPI:1437141702
Name:DEBRA LYNN'S LLC
Entity Type:Organization
Organization Name:DEBRA LYNN'S LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-745-2819
Mailing Address - Street 1:1090 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0784
Mailing Address - Country:US
Mailing Address - Phone:801-393-2885
Mailing Address - Fax:801-393-2885
Practice Address - Street 1:1090 30TH ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-0784
Practice Address - Country:US
Practice Address - Phone:801-393-2885
Practice Address - Fax:801-393-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1265480001Medicare NSC