Healthcare Provider Details

I. General information

NPI: 1275909897
Provider Name (Legal Business Name): DEBBIE IRENE SCAPARDINE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N5157 TRAILS END ST. 282
BRUCE WI
54819
US

IV. Provider business mailing address

N5157 TRAILS END ST. 282
BRUCE WI
54819
US

V. Phone/Fax

Practice location:
  • Phone: 715-828-7867
  • Fax:
Mailing address:
  • Phone: 715-828-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number133548
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: