Provider Demographics
NPI:1154987006
Name:LUTHER, DEBRA ANN (RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:LUTHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 RIVERCHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-5262
Mailing Address - Country:US
Mailing Address - Phone:850-758-9192
Mailing Address - Fax:
Practice Address - Street 1:401 MCEWEN DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2741
Practice Address - Country:US
Practice Address - Phone:850-833-9237
Practice Address - Fax:850-833-9238
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1565002163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator