Provider Demographics
NPI:1316928807
Name:FENTON, DEBRA K (NP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:FENTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5516 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-9374
Mailing Address - Country:US
Mailing Address - Phone:707-279-4489
Mailing Address - Fax:707-275-9066
Practice Address - Street 1:750 OLD LUCERNE RD
Practice Address - Street 2:
Practice Address - City:UPPER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95485-8755
Practice Address - Country:US
Practice Address - Phone:707-275-9066
Practice Address - Fax:707-275-9070
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA332923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily