Provider Demographics
NPI:1336278217
Name:BAHAM, DEBRINA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:DEBRINA
Middle Name:ANN
Last Name:BAHAM
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:PO BOX 751184
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70175-1184
Mailing Address - Country:US
Mailing Address - Phone:504-942-8101
Mailing Address - Fax:504-942-8242
Practice Address - Street 1:719 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-8511
Practice Address - Country:US
Practice Address - Phone:504-942-8101
Practice Address - Fax:504-942-8242
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN067839163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse