Provider Demographics
NPI:1720251804
Name:DREW, DEBRA M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:M
Last Name:DREW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:M
Other - Last Name:OSTERHAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:4192 HUDSON HALLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813
Mailing Address - Country:US
Mailing Address - Phone:608-723-2251
Mailing Address - Fax:
Practice Address - Street 1:4192 HUDSON HALLOW ROAD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813
Practice Address - Country:US
Practice Address - Phone:608-723-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35036500OtherMEDICARE PROVIDER NUMBER