Provider Demographics
NPI:1104802511
Name:THOMAS, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:75438 CHIPPEWA LAKE RD.
Mailing Address - Street 2:
Mailing Address - City:BUTTERNUT
Mailing Address - State:WI
Mailing Address - Zip Code:54514-9998
Mailing Address - Country:US
Mailing Address - Phone:715-769-3714
Mailing Address - Fax:
Practice Address - Street 1:75438 CHIPPEWA LAKE RD.
Practice Address - Street 2:
Practice Address - City:BUTTERNUT
Practice Address - State:WI
Practice Address - Zip Code:54514-9998
Practice Address - Country:US
Practice Address - Phone:715-769-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27609164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse