Healthcare Provider Details

I. General information

NPI: 1023114253
Provider Name (Legal Business Name): DEBRA LYNN BEVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 9TH ST
MANISTEE MI
49660-2100
US

IV. Provider business mailing address

3760 SASS RD
MANISTEE MI
49660-9514
US

V. Phone/Fax

Practice location:
  • Phone: 231-723-8299
  • Fax: 231-723-8761
Mailing address:
  • Phone: 231-723-3735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704177267
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: