Basic Information
| Provider Information | |||||||||
| NPI: | 1578937066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAIN | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5130 ROSE HILL BLVD | ||||||||
| Address2: | |||||||||
| City: | HOLLY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484429507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486345530 | ||||||||
| FaxNumber: | 2485312407 | ||||||||
| Practice Location | |||||||||
| Address1: | 5130 ROSE HILL BLVD | ||||||||
| Address2: | |||||||||
| City: | HOLLY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484429507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486345530 | ||||||||
| FaxNumber: | 2485312407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2015 | ||||||||
| LastUpdateDate: | 11/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA2000X | 4704196417 | MI | N | Nursing Service Providers | Registered Nurse | Administrator | 163WC1500X | 4704196417 | MI | N | Nursing Service Providers | Registered Nurse | Community Health | 163WP0809X | 4704196417 | MI | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.