Provider Demographics
NPI:1114671229
Name:KEY, DEBRA SUE (FNP, PHN, RN)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:SUE
Last Name:KEY
Suffix:
Gender:F
Credentials:FNP, PHN, RN
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:SUE
Other - Last Name:MULDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:353 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-5309
Mailing Address - Country:US
Mailing Address - Phone:626-914-5219
Mailing Address - Fax:
Practice Address - Street 1:353 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-5309
Practice Address - Country:US
Practice Address - Phone:626-914-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520262163W00000X
CA95021188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse