Provider Demographics
NPI:1790584431
Name:STACKHOUSE, DEBRA LYN
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYN
Last Name:STACKHOUSE
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 1:19880 K ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3825
Mailing Address - Country:US
Mailing Address - Phone:402-880-5773
Mailing Address - Fax:
Practice Address - Street 1:19880 K ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3825
Practice Address - Country:US
Practice Address - Phone:402-880-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant