Provider Demographics
NPI:1588943864
Name:HOUSE, DEBRA RUTH (NP)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:RUTH
Last Name:HOUSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:RUTH
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8650 HOWARD CITY EDMORE RD
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-8500
Practice Address - Country:US
Practice Address - Phone:989-352-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704129944363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E96010Medicare PIN