Provider Demographics
NPI:1124319512
Name:ALT, DEBRA JEAN (LPN,DOULA,)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JEAN
Last Name:ALT
Suffix:
Gender:F
Credentials:LPN,DOULA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 NILES RD
Mailing Address - Street 2:
Mailing Address - City:EARLVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13332-2821
Mailing Address - Country:US
Mailing Address - Phone:315-243-4688
Mailing Address - Fax:
Practice Address - Street 1:1085 NILES RD
Practice Address - Street 2:
Practice Address - City:EARLVILLE
Practice Address - State:NY
Practice Address - Zip Code:13332-2821
Practice Address - Country:US
Practice Address - Phone:315-243-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYOGWTDQ3IXH374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula