Prudhom, Debra Kaye

Prudhom, Debra Kaye is an individual health care provider with primary practice located at 3613 Kinzie Ave , Racine WI 53405-2440. She recently has only one registered license in Nursing Service Providers / Registered Nurse, which is considered as her primary health care specialty. Prudhom, Debra Kaye can be contacted via phone (262) 632-4394.

Contact Information

Primary practice address
3613 Kinzie Ave Racine WI 53405-2440
Phone: (262) 632-4394
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 80117 Wisconsin

Profile Details

NPI number 1073582326
LBN Legal business name Prudhom, Debra Kaye
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 17th, 2006
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073582326 NPPES
Wisconsin MEDICAID 38282800

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