Healthcare Provider Details

I. General information

NPI: 1033364567
Provider Name (Legal Business Name): DEBORAH LEE HAHN BSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH LEE SHARP BSN RN

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61619 DOGWOOD RD.
MISHAWAKA IN
46544
US

IV. Provider business mailing address

61619 DOGWOOD RD
MISHAWAKA IN
46544-9744
US

V. Phone/Fax

Practice location:
  • Phone: 574-633-4839
  • Fax:
Mailing address:
  • Phone: 574-633-4839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28167700A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: