Provider Demographics
NPI:1679130041
Name:EGAN, DEBRA JANE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JANE
Last Name:EGAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 SHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-5718
Mailing Address - Country:US
Mailing Address - Phone:228-265-0740
Mailing Address - Fax:
Practice Address - Street 1:1627 SHIRE AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-5718
Practice Address - Country:US
Practice Address - Phone:228-265-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2645579163WL0100X
CA264579163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherTRICARE