Provider Demographics
NPI:1366766875
Name:GRUNDEN, DEBRA LYNN (NURSE)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:GRUNDEN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2732
Mailing Address - Country:US
Mailing Address - Phone:972-551-7500
Mailing Address - Fax:972-524-7418
Practice Address - Street 1:200 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2732
Practice Address - Country:US
Practice Address - Phone:972-551-7500
Practice Address - Fax:972-524-7418
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776939363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX269221YNTKMedicare PIN