Provider Demographics
NPI:1821598665
Name:MAAS, DEBRA KAY (LVN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:MAAS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:SAINT JO
Mailing Address - State:TX
Mailing Address - Zip Code:76265-0158
Mailing Address - Country:US
Mailing Address - Phone:940-902-1197
Mailing Address - Fax:
Practice Address - Street 1:401 WEST WILLIAMS
Practice Address - Street 2:
Practice Address - City:SAINT JO
Practice Address - State:TX
Practice Address - Zip Code:76265
Practice Address - Country:US
Practice Address - Phone:940-902-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196465164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse