Provider Demographics
NPI:1043058092
Name:DEBRULER, AMY LAUREN
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LAUREN
Last Name:DEBRULER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 W LESINA DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1290
Mailing Address - Country:US
Mailing Address - Phone:208-914-4802
Mailing Address - Fax:
Practice Address - Street 1:3144 W BELLTOWER DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4882
Practice Address - Country:US
Practice Address - Phone:208-219-7790
Practice Address - Fax:510-288-0444
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician