Healthcare Provider Details

I. General information

NPI: 1689771602
Provider Name (Legal Business Name): DEBORAH JANE MEARS RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N UNIVERSITY STREET JOHNSON HALL RM B-5
WEST LAFAYETTE IN
47907-2069
US

IV. Provider business mailing address

502 N UNIVERSITY STREET JOHNSON HALL RM B-5
WEST LAFAYETTE IN
47907-2069
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-6341
  • Fax: 765-496-1022
Mailing address:
  • Phone: 765-494-6341
  • Fax: 765-496-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN28074780A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: