Healthcare Provider Details

I. General information

NPI: 1447472550
Provider Name (Legal Business Name): DEBRA LAW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 WILDERS GROVE RD
KINGSTON NH
03848-3550
US

IV. Provider business mailing address

35 JOHN ST
LOWELL MA
01852-1101
US

V. Phone/Fax

Practice location:
  • Phone: 603-997-1634
  • Fax:
Mailing address:
  • Phone: 978-275-3879
  • Fax: 978-275-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number01411422
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2272122
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: