Provider Demographics
NPI:1609376177
Name:GOMEZ, DEBORAH LYNN (RN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:GOMEZ
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 1:2612 79TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2208
Mailing Address - Country:US
Mailing Address - Phone:806-281-8952
Mailing Address - Fax:806-775-9842
Practice Address - Street 1:2612 79TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2208
Practice Address - Country:US
Practice Address - Phone:806-281-8952
Practice Address - Fax:806-775-9842
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653413163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse