Provider Demographics
NPI:1790569911
Name:MENKE, DEBRA KAYE (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAYE
Last Name:MENKE
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 1:14006 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8311
Mailing Address - Country:US
Mailing Address - Phone:515-991-7669
Mailing Address - Fax:
Practice Address - Street 1:14006 S SHORE DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8311
Practice Address - Country:US
Practice Address - Phone:515-991-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063240163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool