Provider Demographics
NPI:1205056363
Name:CRAVEN, DEBORAH JEAN (LPN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEAN
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:566 42ND ST SW
Mailing Address - Street 2:STE #362
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1179
Mailing Address - Country:US
Mailing Address - Phone:701-741-1859
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL5978164W00000X
MNL0317162164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse