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NPI Code Detail

MEDICARE: MRS. DEBRA L IRVINE RN

MEDICARE: MRS. DEBRA L IRVINE RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC1500XCommunity Health Registered NurseRN168765GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RN168765OTHERGAGA REG NURSE LICENSE #

General Provider Information

NPI Number : 1093713786
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEBRA L IRVINE RN
Provider Business Mailing Address
First Line : PO BOX 307
Second Line :
City : CUMMING
State : GA
Zip : 30028-0307
Country : US
Telephone Number : 770-887-1668
Fax Number : 770-781-9937
Provider Business Practice Location Address
First Line : 260 ELM ST
Second Line :
City : CUMMING
State : GA
Zip : 30040-2467
Country : US
Telephone Number : 770-887-1668
Fax Number : 770-781-9937
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 09/11/2007

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Directions to “ MRS. DEBRA L IRVINE RN” Practice Location

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