Provider Demographics
NPI:1912237942
Name:CONFORTI, DEBRA JEAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JEAN
Last Name:CONFORTI
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 1:1459 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2945
Mailing Address - Country:US
Mailing Address - Phone:262-553-1232
Mailing Address - Fax:
Practice Address - Street 1:1459 30TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2945
Practice Address - Country:US
Practice Address - Phone:262-553-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI302491-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI$$$$$$$$$OtherSOCIAL SECURITY NUMBER (SSN) IS ALL THAT I HAVE
WI$$$$$$$$$OtherSOCIAL SECURITY NUMBER IS ALL THAT I HAVE
WI$$$$$$$$$OtherSOCIAL SECURITY