Healthcare Provider Details

I. General information

NPI: 1417193921
Provider Name (Legal Business Name): DEBBIE J NORMAN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E TAM O SHANTER ST
ONTARIO CA
91761-6354
US

IV. Provider business mailing address

1525 E TAM O SHANTER ST
ONTARIO CA
91761-6354
US

V. Phone/Fax

Practice location:
  • Phone: 909-947-8211
  • Fax:
Mailing address:
  • Phone: 909-947-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number468231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: