Provider Demographics
NPI:1679673883
Name:CARLSON, DEBRA JEAN (RP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JEAN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8962 COUNTY ROAD 3
Mailing Address - Street 2:
Mailing Address - City:NICKERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68044-2511
Mailing Address - Country:US
Mailing Address - Phone:402-478-4134
Mailing Address - Fax:402-478-4134
Practice Address - Street 1:238 S 8TH ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-2410
Practice Address - Country:US
Practice Address - Phone:402-426-9066
Practice Address - Fax:402-426-9069
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080946600Medicaid