Provider Demographics
NPI:1629571922
Name:MAHAN, DEBORAH PECK (RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:PECK
Last Name:MAHAN
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 1:1517 GLENMEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2804
Mailing Address - Country:US
Mailing Address - Phone:512-771-9098
Mailing Address - Fax:
Practice Address - Street 1:1517 GLENMEADOWS DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2804
Practice Address - Country:US
Practice Address - Phone:512-771-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX637740163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse