Provider Demographics
NPI:1447472550
Name:LAW, DEBRA (RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1101
Mailing Address - Country:US
Mailing Address - Phone:978-275-3879
Mailing Address - Fax:978-275-6480
Practice Address - Street 1:18 WILDERS GROVE RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-3550
Practice Address - Country:US
Practice Address - Phone:603-997-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01411422164W00000X
MARN2272122163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse