Provider Demographics
NPI:1356587372
Name:DEBNAM, DONALD SHANE (FNP)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:SHANE
Last Name:DEBNAM
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Gender:M
Credentials:FNP
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Mailing Address - Street 1:P.O. BOX 35800
Mailing Address - Street 2:GPI - PLANT 70 MEDICAL CENTER
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-5800
Mailing Address - Country:US
Mailing Address - Phone:318-362-2099
Mailing Address - Fax:318-362-2775
Practice Address - Street 1:1070 JONESBORO ROAD
Practice Address - Street 2:GPI - PLANT 70 MEDICAL CENTER
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292
Practice Address - Country:US
Practice Address - Phone:318-362-2099
Practice Address - Fax:318-362-2775
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
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Provider Licenses
StateLicense IDTaxonomies
LARN084552-AP04146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily