Healthcare Provider Details

I. General information

NPI: 1235756180
Provider Name (Legal Business Name): DEBRA LEA ENGLAND STEVENS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 10/24/2020
Certification Date: 10/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 LAKE ST UNIT B
BRISTOL NH
03222-4507
US

IV. Provider business mailing address

72 ALPINE RD
BRISTOL NH
03222-5328
US

V. Phone/Fax

Practice location:
  • Phone: 603-530-2228
  • Fax:
Mailing address:
  • Phone: 603-530-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number063312-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number063312-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: