Provider Demographics
NPI:1497306518
Name:RAVEN, DEBORAH SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SUE
Last Name:RAVEN
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 1:909 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4519
Mailing Address - Country:US
Mailing Address - Phone:402-390-2100
Mailing Address - Fax:402-390-2136
Practice Address - Street 1:909 S 76TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4519
Practice Address - Country:US
Practice Address - Phone:402-390-2100
Practice Address - Fax:402-390-2136
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE43286163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse