Provider Demographics
NPI:1750722542
Name:LANDSOM, DEBRA SUE
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:LANDSOM
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 1:37379 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:MN
Mailing Address - Zip Code:55018-7253
Mailing Address - Country:US
Mailing Address - Phone:507-273-1080
Mailing Address - Fax:
Practice Address - Street 1:37379 2ND AVE
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:MN
Practice Address - Zip Code:55018-7253
Practice Address - Country:US
Practice Address - Phone:507-273-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIR141402-2163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health