Provider Demographics
NPI:1063728244
Name:SVENVOLD, DEBRA L (LPN)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:L
Last Name:SVENVOLD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:RAETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:15439 SE 142ND PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-7402
Mailing Address - Country:US
Mailing Address - Phone:425-255-7930
Mailing Address - Fax:
Practice Address - Street 1:15439 SE 142ND PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-7402
Practice Address - Country:US
Practice Address - Phone:425-255-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00036176164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse