Provider Demographics
NPI:1982896692
Name:BEVILLE, DEBRA S (CPNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:BEVILLE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1703 W STONES CROSSING RD STE 330
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8558
Practice Address - Country:US
Practice Address - Phone:317-887-6060
Practice Address - Fax:317-859-5944
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2023-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28062062A363LP0200X
IN71000046A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics