Provider Demographics
NPI:1992195465
Name:CULBERSON, DEANNA (RN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:CULBERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:LACOURCIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:43421 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1133
Mailing Address - Country:US
Mailing Address - Phone:586-263-2852
Mailing Address - Fax:586-263-2621
Practice Address - Street 1:43421 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1133
Practice Address - Country:US
Practice Address - Phone:586-263-2852
Practice Address - Fax:586-263-2621
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704132164163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management