Provider Demographics
NPI:1760004030
Name:USCHAN, DEBORAH ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELLEN
Last Name:USCHAN
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 1:704 WEALD BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-8306
Mailing Address - Country:US
Mailing Address - Phone:608-333-6676
Mailing Address - Fax:
Practice Address - Street 1:704 WEALD BRIDGE RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-8306
Practice Address - Country:US
Practice Address - Phone:608-333-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI140276-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse