Healthcare Provider Details

I. General information

NPI: 1629776075
Provider Name (Legal Business Name): DEBRA LYNNE MARTIN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11707 MOYER RD
WEBBERVILLE MI
48892-9521
US

IV. Provider business mailing address

11707 MOYER RD
WEBBERVILLE MI
48892-9521
US

V. Phone/Fax

Practice location:
  • Phone: 517-775-0700
  • Fax:
Mailing address:
  • Phone: 517-775-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704275517
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: