Provider Demographics
NPI:1861628299
Name:MATHIES, DEBRA LYNN (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:MATHIES
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:LETZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2451 INTELLIPLEX DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8580
Mailing Address - Country:US
Mailing Address - Phone:317-421-1914
Mailing Address - Fax:317-398-1853
Practice Address - Street 1:2451 INTELLIPLEX DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8580
Practice Address - Country:US
Practice Address - Phone:317-421-1914
Practice Address - Fax:317-398-1853
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002935B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner