Healthcare Provider Details

I. General information

NPI: 1972632099
Provider Name (Legal Business Name): DEBRA LYNN BLECKER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7676 NEW HAMPSHIRE AVE #220A
TAKOMA PARK MD
20912-7512
US

IV. Provider business mailing address

625 GRAND CHAMPION DR
ROCKVILLE MD
20850-5970
US

V. Phone/Fax

Practice location:
  • Phone: 240-751-2776
  • Fax:
Mailing address:
  • Phone: 301-330-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR118364
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: