Provider Demographics
NPI:1780052381
Name:PETERS, DEBRA (LPN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:PETERS
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 1:1200 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9797
Mailing Address - Country:US
Mailing Address - Phone:734-646-4883
Mailing Address - Fax:
Practice Address - Street 1:1515 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-4047
Practice Address - Country:US
Practice Address - Phone:517-787-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703102665164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse