Provider Demographics
NPI:1548276058
Name:FAJKOWSKI, DEBORAH ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:FAJKOWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1430 OLIVE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2303
Mailing Address - Country:US
Mailing Address - Phone:573-747-2461
Mailing Address - Fax:573-756-4316
Practice Address - Street 1:1085 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1955
Practice Address - Country:US
Practice Address - Phone:573-747-2461
Practice Address - Fax:573-756-4316
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO129776163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health