Provider Demographics
NPI:1295962959
Name:JOHNSON, DEBRA MARLENE (RN)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MARLENE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MARLENE
Other - Last Name:HOLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:MN
Mailing Address - Zip Code:56511
Mailing Address - Country:US
Mailing Address - Phone:218-439-6364
Mailing Address - Fax:
Practice Address - Street 1:106 4TH AVENUE NORTH
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:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR132125-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse