Provider Demographics
NPI:1467804567
Name:TENTER, DEBORA (NP)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:TENTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 HOLLYWOOD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8510
Mailing Address - Country:US
Mailing Address - Phone:269-428-0819
Mailing Address - Fax:269-428-0841
Practice Address - Street 1:3800 HOLLYWOOD RD STE 104
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8511
Practice Address - Country:US
Practice Address - Phone:269-428-0819
Practice Address - Fax:269-428-0841
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704157430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily