Provider Demographics
NPI:1477617157
Name:MALLORY, DEBRA LYNN (NP, PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYNN
Last Name:MALLORY
Suffix:
Gender:F
Credentials:NP, PHD
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:LUEGENBIEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, PHD
Mailing Address - Street 1:1530 N 7TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-1057
Mailing Address - Country:US
Mailing Address - Phone:812-238-3800
Mailing Address - Fax:812-478-7676
Practice Address - Street 1:27 E CRESTHILL RD
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4985
Practice Address - Country:US
Practice Address - Phone:812-298-1415
Practice Address - Fax:812-237-3358
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001184A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health