Provider Demographics
NPI:1669793626
Name:MACDONALD, DEBRA KAY (LPN)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:KAY
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVART
Mailing Address - State:MI
Mailing Address - Zip Code:49631-9530
Mailing Address - Country:US
Mailing Address - Phone:231-734-3403
Mailing Address - Fax:
Practice Address - Street 1:344 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:EVART
Practice Address - State:MI
Practice Address - Zip Code:49631-9530
Practice Address - Country:US
Practice Address - Phone:231-734-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703036203164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse