Provider Demographics
NPI:1063501765
Name:GAVES, DEBRA JEAN (NP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEAN
Last Name:GAVES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 QUEEN ST STE 13
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2478
Mailing Address - Country:US
Mailing Address - Phone:508-860-7800
Mailing Address - Fax:508-796-7014
Practice Address - Street 1:26 QUEEN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2478
Practice Address - Country:US
Practice Address - Phone:508-860-7800
Practice Address - Fax:508-796-7014
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704170436363L00000X
MARN10003464363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ44743Medicare UPIN