Provider Demographics
NPI:1952637209
Name:BURCH, DEBRA S (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:BURCH
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 1:351 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-9686
Mailing Address - Country:US
Mailing Address - Phone:706-554-4435
Mailing Address - Fax:706-554-4435
Practice Address - Street 1:351 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-9686
Practice Address - Country:US
Practice Address - Phone:706-554-4435
Practice Address - Fax:706-554-4435
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN049451163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse