Provider Demographics
NPI:1053718791
Name:DAMIOLI, DEBRA A (NP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:A
Last Name:DAMIOLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42855 GARFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5027
Mailing Address - Country:US
Mailing Address - Phone:586-226-1387
Mailing Address - Fax:586-226-1859
Practice Address - Street 1:42855 GARFIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5027
Practice Address - Country:US
Practice Address - Phone:586-226-1387
Practice Address - Fax:586-226-1859
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704237762363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner