Healthcare Provider Details

I. General information

NPI: 1205103835
Provider Name (Legal Business Name): DEBBIE ANN MABLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 E. 84TH PLACE
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

1471 E. 84TH PLACE
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-8630
  • Fax: 219-769-8633
Mailing address:
  • Phone: 219-769-8630
  • Fax: 219-769-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28139356A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: