MEDICARE: MS. DEBORAH LYNNE ECKERT N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	4704176180	MI

General Provider Information

NPI Number	:	1588664254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH LYNNE ECKERT N.P.

Provider Business Mailing Address
First Line	:	1701 BALDWIN AVE
Second Line	:	SUITE 101
City	:	PONTIAC
State	:	MI
Zip	:	48340-3412
Country	:	US
Telephone Number	:	248-409-0585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 BALDWIN AVE
Second Line	:	SUITE 101
City	:	PONTIAC
State	:	MI
Zip	:	48340-3412
Country	:	US
Telephone Number	:	248-409-0585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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