Provider Demographics
NPI:1588647473
Name:HYSELL, DEBRA (APN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:HYSELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1618
Mailing Address - Country:US
Mailing Address - Phone:815-654-9224
Mailing Address - Fax:
Practice Address - Street 1:314 LINCOLN HWY
Practice Address - Street 2:YOUR FAMILY DOCTOR LOWER LEVEL
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1638
Practice Address - Country:US
Practice Address - Phone:815-562-5100
Practice Address - Fax:815-562-5228
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL705070Medicare ID - Type UnspecifiedMEDICARE
ILP32934Medicare UPIN