Provider Demographics
NPI:1972632099
Name:BLECKER, DEBRA LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LYNN
Last Name:BLECKER
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 1:625 GRAND CHAMPION DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5970
Mailing Address - Country:US
Mailing Address - Phone:301-330-0927
Mailing Address - Fax:
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE
Practice Address - Street 2:#220A
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7512
Practice Address - Country:US
Practice Address - Phone:240-751-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR118364163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management