Healthcare Provider Details

I. General information

NPI: 1689808628
Provider Name (Legal Business Name): DEBORAH L VANBEUKERING D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 HIGHWAY 51 S
COVINGTON TN
38019-3623
US

IV. Provider business mailing address

1998 HIGHWAY 51 S
COVINGTON TN
38019-3623
US

V. Phone/Fax

Practice location:
  • Phone: 901-476-1155
  • Fax: 901-475-2940
Mailing address:
  • Phone: 901-476-1155
  • Fax: 901-475-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberD01036
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: