Provider Demographics
NPI:1588664254
Name:ECKERT, DEBORAH LYNNE (NP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LYNNE
Last Name:ECKERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 BALDWIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-3412
Mailing Address - Country:US
Mailing Address - Phone:248-409-0585
Mailing Address - Fax:
Practice Address - Street 1:1701 BALDWIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-3412
Practice Address - Country:US
Practice Address - Phone:248-409-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704176180363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health