Healthcare Provider Details

I. General information

NPI: 1114671229
Provider Name (Legal Business Name): DEBRA SUE KEY FNP, PHN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. DEBRA SUE MULDER

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 W FOOTHILL BLVD
GLENDORA CA
91741-5309
US

IV. Provider business mailing address

353 W FOOTHILL BLVD
GLENDORA CA
91741-5309
US

V. Phone/Fax

Practice location:
  • Phone: 626-914-5219
  • Fax:
Mailing address:
  • Phone: 626-914-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021188
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number520262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: