Provider Demographics
NPI:1063783959
Name:ADAMS, DEBRA A (BA, LVN)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:A
Last Name:ADAMS
Suffix:
Gender:F
Credentials:BA, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 EVA ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4717
Mailing Address - Country:US
Mailing Address - Phone:805-302-7677
Mailing Address - Fax:
Practice Address - Street 1:72 MOODY CT STE 201
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7427
Practice Address - Country:US
Practice Address - Phone:805-777-3505
Practice Address - Fax:805-777-3574
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN220938164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse