Provider Demographics
NPI:1477012060
Name:MAXSON, DEBRA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEAN
Last Name:MAXSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10060 FRONTIER RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9517
Mailing Address - Country:US
Mailing Address - Phone:517-254-4519
Mailing Address - Fax:
Practice Address - Street 1:10060 FRONTIER RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9517
Practice Address - Country:US
Practice Address - Phone:517-254-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704121051163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse