Provider Demographics
NPI:1629114889
Name:DEJEAN-EATON, DEBORAH JEANNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEANNE
Last Name:DEJEAN-EATON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1016
Mailing Address - Street 2:
Mailing Address - City:COUSHATTA
Mailing Address - State:LA
Mailing Address - Zip Code:71019-1016
Mailing Address - Country:US
Mailing Address - Phone:318-932-4029
Mailing Address - Fax:318-932-5914
Practice Address - Street 1:1313 RINGGOLD AVE.
Practice Address - Street 2:
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019
Practice Address - Country:US
Practice Address - Phone:318-932-4029
Practice Address - Fax:318-932-5914
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN033780163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult