Provider Demographics
NPI:1194070227
Name:HABER, DEBRA ROUSE (RN, MS, AGNP-C, DNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ROUSE
Last Name:HABER
Suffix:
Gender:F
Credentials:RN, MS, AGNP-C, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 BREN RD E
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9664
Mailing Address - Country:US
Mailing Address - Phone:520-224-4537
Mailing Address - Fax:
Practice Address - Street 1:755 S GRAPEVINE LOOP
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-7430
Practice Address - Country:US
Practice Address - Phone:520-490-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-15
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4654363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ729716Medicaid
AZ729716Medicaid