Provider Demographics
NPI:1700946092
Name:POMAZAL, DEBORAH LEE (RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:POMAZAL
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:N63W29096 TAIL BAND CT
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-9452
Mailing Address - Country:US
Mailing Address - Phone:262-424-7867
Mailing Address - Fax:
Practice Address - Street 1:N63W29096 TAIL BAND CT
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-9452
Practice Address - Country:US
Practice Address - Phone:262-424-7867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67253-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39944900Medicaid