Provider Demographics
NPI:1699075192
Name:UPDEGRAFF, DEBRA UPDEGRAFF (RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:UPDEGRAFF
Last Name:UPDEGRAFF
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 1:1455 PARKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6050
Mailing Address - Country:US
Mailing Address - Phone:925-216-0903
Mailing Address - Fax:
Practice Address - Street 1:1455 PARKVIEW CT
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6050
Practice Address - Country:US
Practice Address - Phone:925-216-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN453151163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine