Healthcare Provider Details

I. General information

NPI: 1851731426
Provider Name (Legal Business Name): DEBRA L SYPERT CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MILLER RD
ROWLETT TX
75088-5604
US

IV. Provider business mailing address

1901 MILLER RD
ROWLETT TX
75088-5604
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number85112
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: