Healthcare Provider Details

I. General information

NPI: 1891055448
Provider Name (Legal Business Name): DEBORAH MARIE YEARY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 11/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 STARWICK DR
ANN ARBOR MI
48105-1285
US

IV. Provider business mailing address

865 STARWICK DR
ANN ARBOR MI
48105-1285
US

V. Phone/Fax

Practice location:
  • Phone: 734-276-8885
  • Fax:
Mailing address:
  • Phone: 734-276-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704199503
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: