Provider Demographics
NPI:1457929986
Name:OHNSTAD, DEBRA AMANDA MARIE
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:AMANDA MARIE
Last Name:OHNSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 KEARNEY AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3016
Mailing Address - Country:US
Mailing Address - Phone:307-262-1276
Mailing Address - Fax:
Practice Address - Street 1:1774 KEARNEY AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3016
Practice Address - Country:US
Practice Address - Phone:307-262-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19910163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management