Provider Demographics
NPI:1548326747
Name:MULRY, DEBRA ANN (RN)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:MULRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3712
Mailing Address - Country:US
Mailing Address - Phone:631-374-9936
Mailing Address - Fax:631-654-3391
Practice Address - Street 1:145 BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3712
Practice Address - Country:US
Practice Address - Phone:631-374-9936
Practice Address - Fax:631-654-3391
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY371173-1163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02680211Medicaid