Healthcare Provider Details

I. General information

NPI: 1467536557
Provider Name (Legal Business Name): DEBRA DIAN RUMSEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 4TH STREET ELDORADO RURAL HEALTH CLINIC
ELDORADO IL
62930
US

IV. Provider business mailing address

PO BOX 155 REA CLINIC
CHRISTOPHER IL
62822
US

V. Phone/Fax

Practice location:
  • Phone: 618-273-9328
  • Fax: 618-273-2726
Mailing address:
  • Phone: 618-724-2401
  • Fax: 618-724-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number04304228
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: