Provider Demographics
NPI:1013233410
Name:MARTIN, DEBRA JEAN (LPN)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JEAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:JEAN
Other - Last Name:YRIGOLLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2477 LAKEVIEW DR APT 202
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-4521
Mailing Address - Country:US
Mailing Address - Phone:541-221-8982
Mailing Address - Fax:
Practice Address - Street 1:2477 LAKEVIEW DR APT 202
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-4521
Practice Address - Country:US
Practice Address - Phone:541-221-8982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200930504LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse