Provider Demographics
NPI:1790840932
Name:KLEZMER, DEBRA (LMT,RN,C,CRRN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KLEZMER
Suffix:
Gender:F
Credentials:LMT,RN,C,CRRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 DIAUTO DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4510
Mailing Address - Country:US
Mailing Address - Phone:781-986-6443
Mailing Address - Fax:781-986-4837
Practice Address - Street 1:42 DIAUTO DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-6202
Practice Address - Country:US
Practice Address - Phone:781-986-6443
Practice Address - Fax:781-986-4837
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145673163WP0000X
MA079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0000XNursing Service ProvidersRegistered NursePain Management
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ04319OtherBCBS OF MA