Individual
DEBRA NULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1904 RICHLAND AVE BLDG A, CERES, CA 95307-4562
(209) 300-8800
Mailing address
2621 PRESCOTT RD SPC 144, MODESTO, CA 95350-0256
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
268531
CA
Other
Enumeration date
09/18/2018
Last updated
09/18/2018
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