Provider Demographics
NPI:1154407302
Name:MCMIRE, DEBRA (MSN FNPC)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:MCMIRE
Suffix:
Gender:F
Credentials:MSN FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ARDSLEY PLACE
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036
Mailing Address - Country:US
Mailing Address - Phone:609-267-3788
Mailing Address - Fax:
Practice Address - Street 1:824 N BLACK HORSE PIKE
Practice Address - Street 2:MINUTE CLINIC
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1034
Practice Address - Country:US
Practice Address - Phone:856-939-5656
Practice Address - Fax:856-312-0265
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN070868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123767XVAMedicare UPIN