Provider Demographics
NPI:1760609010
Name:MASTERS, DEBRA L
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:MASTERS
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 1:10275 E RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8441
Mailing Address - Country:US
Mailing Address - Phone:810-743-0651
Mailing Address - Fax:810-743-2177
Practice Address - Street 1:4047 S CENTER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48519-1453
Practice Address - Country:US
Practice Address - Phone:810-743-0651
Practice Address - Fax:810-743-2177
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704201075163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health