Provider Demographics
NPI:1144980087
Name:KHAN, DEBRA (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14145 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7884
Mailing Address - Country:US
Mailing Address - Phone:515-783-4897
Mailing Address - Fax:
Practice Address - Street 1:2346 N GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5512
Practice Address - Country:US
Practice Address - Phone:033-832-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085025163W00000X
WA61210869163W00000X
CORN.1689115163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse