Provider Demographics
NPI:1730735077
Name:KRUZAN, DEBRA S
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:S
Last Name:KRUZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13785 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-8377
Mailing Address - Country:US
Mailing Address - Phone:309-241-5363
Mailing Address - Fax:
Practice Address - Street 1:13785 1ST ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-8377
Practice Address - Country:US
Practice Address - Phone:309-241-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider