Healthcare Provider Details

I. General information

NPI: 1225190200
Provider Name (Legal Business Name): DEBORAH H BRISSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MERCER ROAD
ELIZABETHTOWN NC
28337
US

IV. Provider business mailing address

300 MERCER MILL ROAD
ELIZABETHTOWN NC
28337-0189
US

V. Phone/Fax

Practice location:
  • Phone: 910-872-6214
  • Fax:
Mailing address:
  • Phone: 910-872-6214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number132640
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: