Provider Demographics
NPI:1477282713
Name:EASTMAN, DEBRA (RN, CNS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44749 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3245
Mailing Address - Country:US
Mailing Address - Phone:734-658-5500
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR SPC 5116
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5116
Practice Address - Country:US
Practice Address - Phone:734-423-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704159215364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist