Provider Demographics
NPI:1710266374
Name:DEBAH, RITA BROWN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:RITA
Middle Name:BROWN
Last Name:DEBAH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 UNDERCLIFF AVE
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6742
Mailing Address - Country:US
Mailing Address - Phone:347-820-5686
Mailing Address - Fax:
Practice Address - Street 1:1706 UNDERCLIFF AVE
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-6742
Practice Address - Country:US
Practice Address - Phone:347-820-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305610-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse