1154407302 NPI number — MRS. DEBRA MCMIRE MSN FNPC

Table of content: MRS. DEBRA MCMIRE MSN FNPC (NPI 1154407302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154407302 NPI number — MRS. DEBRA MCMIRE MSN FNPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMIRE
Provider First Name:
DEBRA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN FNPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154407302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 ARDSLEY PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAINESPORT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-267-3788
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
824 N BLACK HORSE PIKE
Provider Second Line Business Practice Location Address:
MINUTE CLINIC
Provider Business Practice Location Address City Name:
RUNNEMEDE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08078-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-939-5656
Provider Business Practice Location Address Fax Number:
856-312-0265
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NN070868 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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