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Individual

DEBRA REFORMAT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
508 HEATHER FALLS CT, ROSEVILLE, CA 95678-3423
(916) 358-0201
Mailing address
7795 ANTELOPE RD, APT. 25, CITRUS HEIGHTS, CA 95610-2365
(916) 358-0201

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
277469-1
NY
164X00000X
Licensed Vocational Nurse
Primary
279309
CA

Other

Enumeration date
04/14/2010
Last updated
07/07/2015
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