Provider Demographics
NPI:1336156967
Name:RAUMAKITA, DEBRA J (APNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:RAUMAKITA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:J
Other - Last Name:HALLORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1813 W HARVARD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2754
Mailing Address - Country:US
Mailing Address - Phone:541-440-6390
Mailing Address - Fax:541-440-6392
Practice Address - Street 1:1813 W HARVARD AVE STE 201
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2754
Practice Address - Country:US
Practice Address - Phone:541-440-6390
Practice Address - Fax:541-440-6392
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2430363L00000X
OR21504712NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41271700Medicaid
WIQ49612Medicare UPIN