Healthcare Provider Details

I. General information

NPI: 1427506476
Provider Name (Legal Business Name): DEBRA KOTZE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SAVANNAH RD
LEWES DE
19958-1462
US

IV. Provider business mailing address

32142 DEAN ST
LEWES DE
19958-5793
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3336
  • Fax:
Mailing address:
  • Phone: 410-560-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR119564
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: