Healthcare Provider Details

I. General information

NPI: 1669529806
Provider Name (Legal Business Name): DEBRA ANNE DUBOIS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7424 GREENVILLE AVE SUITE 206
DALLAS TX
75231-4534
US

IV. Provider business mailing address

7424 GREENVILLE AVE SUITE 206
DALLAS TX
75231-4534
US

V. Phone/Fax

Practice location:
  • Phone: 214-363-2004
  • Fax: 214-696-2091
Mailing address:
  • Phone: 214-363-2004
  • Fax: 214-696-2091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number562396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: