Provider Demographics
NPI:1679176622
Name:VANANTWERP, DEBBIE A
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:A
Last Name:VANANTWERP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8144 WAKAZOO WAY
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-9738
Mailing Address - Country:US
Mailing Address - Phone:269-861-5149
Mailing Address - Fax:
Practice Address - Street 1:8144 WAKAZOO WAY
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-9738
Practice Address - Country:US
Practice Address - Phone:269-861-5149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704210651163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse