Provider Demographics
NPI:1023722402
Name:HARRELL, DEBORAH LYNNE
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNNE
Last Name:HARRELL
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 1:1213 WESTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-4308
Mailing Address - Country:US
Mailing Address - Phone:803-624-0746
Mailing Address - Fax:
Practice Address - Street 1:1213 WESTON ST
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-4308
Practice Address - Country:US
Practice Address - Phone:803-624-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health